Provider Demographics
NPI:1497137194
Name:MARRC MEDICAL GROUP
Entity Type:Organization
Organization Name:MARRC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RASHEED
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-290-8700
Mailing Address - Street 1:2952 HEART PINE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7639
Mailing Address - Country:US
Mailing Address - Phone:402-290-8700
Mailing Address - Fax:
Practice Address - Street 1:2952 HEART PINE WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7639
Practice Address - Country:US
Practice Address - Phone:402-290-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067383208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty