Provider Demographics
NPI:1881665685
Name:WASSON, MARIAN JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:JANE
Last Name:WASSON
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 1:1307 N LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2026
Mailing Address - Country:US
Mailing Address - Phone:864-488-1333
Mailing Address - Fax:864-488-3004
Practice Address - Street 1:1307 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2026
Practice Address - Country:US
Practice Address - Phone:864-488-1333
Practice Address - Fax:864-488-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC32354OtherMEDCOST
SC88808Medicaid
SC4545148OtherAETNA
NC890581CMedicaid
SC4545148OtherAETNA
SC88808Medicaid
NC890581CMedicaid