Provider Demographics
NPI:1003902099
Name:SEVERE, MARIE MYRTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MYRTHA
Last Name:SEVERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:MYRTHA
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-8606
Mailing Address - Country:US
Mailing Address - Phone:478-714-8667
Mailing Address - Fax:478-225-9720
Practice Address - Street 1:1120 MORNINGSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:PERRRY
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-988-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine