Provider Demographics
NPI:1114969656
Name:FINCH, MARCUS DONALD
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:DONALD
Last Name:FINCH
Suffix:
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-928-4412
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:805 HALL ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2110
Practice Address - Country:US
Practice Address - Phone:601-928-4412
Practice Address - Fax:601-928-4792
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5826661OtherAETNA
MS06475751Medicaid
MS3666657OtherCIGNA
MSP00791979OtherRAILROAD MEDICARE
MS5826661OtherAETNA
MS302I979090Medicare PIN