Provider Demographics
NPI:1144782392
Name:MARR, PEYTON REYNOLDS (DO)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:REYNOLDS
Last Name:MARR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PEYTON
Other - Middle Name:L
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5640
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:948 CYPRESS VILLAGE BLVD., UNIT A
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-5640
Practice Address - Country:US
Practice Address - Phone:813-633-3002
Practice Address - Fax:813-633-6392
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19853207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program