Provider Demographics
NPI:1457364986
Name:MARQUESS, STEPHEN RICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RICK
Last Name:MARQUESS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 HIGHWAY 124 W
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-3116
Mailing Address - Country:US
Mailing Address - Phone:706-548-4044
Mailing Address - Fax:
Practice Address - Street 1:892 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2724
Practice Address - Country:US
Practice Address - Phone:706-548-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer