Provider Demographics
NPI:1518028356
Name:MAYES, MARC STEPHEN (PA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:STEPHEN
Last Name:MAYES
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1 SISKIN PLZ
Mailing Address - Street 2:STE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1306
Mailing Address - Country:US
Mailing Address - Phone:423-803-2226
Mailing Address - Fax:423-803-2222
Practice Address - Street 1:1 SISKIN PLZ
Practice Address - Street 2:STE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1306
Practice Address - Country:US
Practice Address - Phone:423-803-2226
Practice Address - Fax:423-803-2222
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
TN1417363A00000X
GA005097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3668464Medicaid
TN3668464Medicaid
GA97WCJWBMedicare PIN