Provider Demographics
NPI:1043857501
Name:WEBB, MARION E JR
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:E
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-0156
Mailing Address - Country:US
Mailing Address - Phone:803-422-5677
Mailing Address - Fax:
Practice Address - Street 1:340 AIKEN RD
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9176
Practice Address - Country:US
Practice Address - Phone:803-422-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider