Provider Demographics
NPI:1912208661
Name:JACOBS, MARSHA G (RCS, RVS)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:G
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RCS, RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-0710
Mailing Address - Country:US
Mailing Address - Phone:910-318-3557
Mailing Address - Fax:910-276-3291
Practice Address - Street 1:8680 ASHTON DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-0710
Practice Address - Country:US
Practice Address - Phone:910-318-3557
Practice Address - Fax:910-276-3291
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25204246XC2903X, 246XS1301X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography