Provider Demographics
NPI:1497420897
Name:MARCUS, JARRELL
Entity Type:Individual
Prefix:
First Name:JARRELL
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N LESTER RD
Mailing Address - Street 2:
Mailing Address - City:BACONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31716-7765
Mailing Address - Country:US
Mailing Address - Phone:404-395-4863
Mailing Address - Fax:
Practice Address - Street 1:132 N LESTER RD
Practice Address - Street 2:
Practice Address - City:BACONTON
Practice Address - State:GA
Practice Address - Zip Code:31716-7765
Practice Address - Country:US
Practice Address - Phone:404-395-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management