Provider Demographics
NPI:1063438950
Name:MARSH, ARTHUR CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:CLIFFORD
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5809
Mailing Address - Country:US
Mailing Address - Phone:229-985-1334
Mailing Address - Fax:229-891-2508
Practice Address - Street 1:1315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5809
Practice Address - Country:US
Practice Address - Phone:229-985-1334
Practice Address - Fax:229-891-2508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000637942AMedicaid
GA08BDHTLMedicare ID - Type Unspecified
GA000637942AMedicaid