Provider Demographics
NPI:1851376776
Name:MARCUS, DENNIS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3685 WHEELER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6446
Mailing Address - Country:US
Mailing Address - Phone:706-650-0061
Mailing Address - Fax:706-650-0064
Practice Address - Street 1:3685 WHEELER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6446
Practice Address - Country:US
Practice Address - Phone:706-650-0061
Practice Address - Fax:706-650-0064
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038552207W00000X
SCMD19274207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000605283BMedicaid
SCG38552Medicaid
GA18BDFPHMedicare PIN
GAF45908Medicare UPIN
SCG38552Medicaid
GA000605283BMedicaid
GA180038220Medicare PIN