Provider Demographics
NPI:1740387893
Name:MARKS, LEAH BENTON (APRN,BC,FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:BENTON
Last Name:MARKS
Suffix:
Gender:F
Credentials:APRN,BC,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 HODGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-4808
Mailing Address - Country:US
Mailing Address - Phone:912-728-7884
Mailing Address - Fax:
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-355-8136
Practice Address - Fax:912-352-7014
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084830363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG36294Medicare UPIN
GAE42592Medicare UPIN