Provider Demographics
NPI:1235203167
Name:CORKERN, MARCY MAY (RPH)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:MAY
Last Name:CORKERN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 2960
Mailing Address - Street 2:
Mailing Address - City:ALAPAHA
Mailing Address - State:GA
Mailing Address - Zip Code:31622-9554
Mailing Address - Country:US
Mailing Address - Phone:229-533-7659
Mailing Address - Fax:
Practice Address - Street 1:717 2ND ST W
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4201
Practice Address - Country:US
Practice Address - Phone:229-382-3711
Practice Address - Fax:229-387-2751
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022004183500000X
LA16326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0416380001Medicare ID - Type Unspecified
GA1152482Medicare UPIN