Provider Demographics
NPI:1487736534
Name:MARZETTA, MARTHA R (RN, ACNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:R
Last Name:MARZETTA
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-257-0006
Mailing Address - Fax:404-851-1316
Practice Address - Street 1:960 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:404-851-1316
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695301363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7035OtherBCBS
TX165354501Medicaid
TX165354501Medicaid
TX8B9469Medicare PIN