Provider Demographics
NPI:1427344746
Name:SHERIDAN, MARISSA COOK (NP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:COOK
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1404
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6098
Mailing Address - Country:US
Mailing Address - Phone:678-347-2153
Mailing Address - Fax:770-995-0472
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1404
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6098
Practice Address - Country:US
Practice Address - Phone:678-347-2153
Practice Address - Fax:770-995-0472
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA184901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily