Provider Demographics
NPI:1275599003
Name:MARNELL, EUGENE RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:RICHARD
Last Name:MARNELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:P.O. BOX 3129
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3129
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:630 13TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1015
Practice Address - Country:US
Practice Address - Phone:706-774-5000
Practice Address - Fax:706-823-5928
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0478002085R0204X, 2085D0003X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA610062310BMedicaid
GA610062310CMedicaid
1346357217OtherNPI - VASCULAR RADIOLOGY
SCG47800Medicaid
GA610062310AMedicaid
1346357217OtherNPI - VASCULAR RADIOLOGY
GA610062310BMedicaid