Provider Demographics
NPI:1942521067
Name:MARLER, KEVIN L
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:MARLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GOLDEN CT
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2367
Mailing Address - Country:US
Mailing Address - Phone:770-841-3048
Mailing Address - Fax:678-802-1867
Practice Address - Street 1:21 GOLDEN CT
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2367
Practice Address - Country:US
Practice Address - Phone:770-841-3048
Practice Address - Fax:678-802-1867
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2084371712471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography