Provider Demographics
NPI:1366492209
Name:HUSID, MARC S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:HUSID
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Gender:M
Credentials:MD
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Mailing Address - Street 1:300 E HOSPITAL ROAD
Mailing Address - Street 2:NEUROSCIENCE AND REHAB CENTER ROOM 12C 12
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-787-2697
Mailing Address - Fax:706-787-1327
Practice Address - Street 1:300 E HOSPITAL ROAD
Practice Address - Street 2:NEUROSCIENCE AND REHAB CENTER ROOM 12C 12
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-2697
Practice Address - Fax:706-787-1327
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-10-07
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Provider Licenses
StateLicense IDTaxonomies
GA0514732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00952883AMedicaid
SCG51473Medicaid
GA00952883CMedicaid
GA72BBBBKMedicare PIN
GA00952883AMedicaid