Provider Demographics
NPI:1578780037
Name:IVEY, MARSHALL WRIGHT II (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:WRIGHT
Last Name:IVEY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COBB ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2390
Mailing Address - Country:US
Mailing Address - Phone:478-453-9383
Mailing Address - Fax:
Practice Address - Street 1:750 N COBB ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2390
Practice Address - Country:US
Practice Address - Phone:478-453-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics