Provider Demographics
NPI:1184683377
Name:DUNAWAY, MARSHALL C
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:C
Last Name:DUNAWAY
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 1:119 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6618
Mailing Address - Country:US
Mailing Address - Phone:229-225-1900
Mailing Address - Fax:229-225-3493
Practice Address - Street 1:119 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6618
Practice Address - Country:US
Practice Address - Phone:229-225-1900
Practice Address - Fax:229-225-3493
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDFRFMedicare PIN
GAD39777Medicare UPIN