Provider Demographics
NPI:1174676803
Name:PRESCOTT, MARCIA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ANNE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BAKERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134
Mailing Address - Country:US
Mailing Address - Phone:770-947-2311
Mailing Address - Fax:770-947-2347
Practice Address - Street 1:1111 BAKERS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-947-2311
Practice Address - Fax:770-947-2347
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047483820AMedicaid