Provider Demographics
NPI:1164623989
Name:TSCHEPIKOW, MARLA S (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:S
Last Name:TSCHEPIKOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:SHEA
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:1500 OGLETHORPE AVE STE 200C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2165
Practice Address - Country:US
Practice Address - Phone:706-389-3875
Practice Address - Fax:706-389-3876
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine