Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marissa Lynette Commodore, CRNA

Individual provider Anesthesiology Physician · NPI 1881264356

Marissa Lynette Commodore, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Stone Mountain, Georgia. Qualified in 2023, 3 years ago. Practices with Piedmont Anesthesia LLC, a 554-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
3
Licensed in
GA
In the registry since
2021
Specialties on file
2
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

5357 Windfern Ct
Stone Mountain, GA 30088-3329
Phone: (770) 875-3080
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence RN264280 (GA)
Anesthesiology Physician Taxonomy 207L00000X · Licence RN264280 (GA)

Record details

NPI number1881264356
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJune 28, 2021
Last updated in NPPESMay 23, 2024
Certification dateMay 23, 2024
Mailing address5357 Windfern Ct, Stone Mountain, GA 30088-3329

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Piedmont Anesthesia Llc — 554 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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