Provider Demographics
NPI:1679061626
Name:LAWRENCE MARSH, MERCEDES SIMONE
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:SIMONE
Last Name:LAWRENCE MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:S
Other - Last Name:LAWRENCE MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3151 REDWOOD RUN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1009
Mailing Address - Country:US
Mailing Address - Phone:678-650-6382
Mailing Address - Fax:
Practice Address - Street 1:225 MILLARD FARMER IND. BLVD BLDG B STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:904-538-0713
Practice Address - Fax:904-538-0714
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-18-54246106S00000X
GA12471217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician