Provider Demographics
NPI:1750323879
Name:FLEMING, MARIANNE MAE (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MAE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3555
Practice Address - Street 1:836 E. 65TH STREET
Practice Address - Street 2:BLDG. 30
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-819-9501
Practice Address - Fax:912-819-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000603897BMedicaid
GA10064426OtherAMERIGROUP
GA349761OtherWELLCARE
SCG35180Medicaid
GA110214425OtherRR MEDICARE
F77449Medicare UPIN
GA11BDSQGMedicare PIN