Provider Demographics
NPI:1154362523
Name:CAUVIN, MARIE JUDITH (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JUDITH
Last Name:CAUVIN
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:PO BOX 102321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2321
Mailing Address - Country:US
Mailing Address - Phone:770-801-2526
Mailing Address - Fax:
Practice Address - Street 1:38 HOSPITAL RD STE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1277
Practice Address - Country:US
Practice Address - Phone:770-251-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70158207Q00000X
GA059135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250711100Medicaid
GA059135OtherGA STATE LICENSE
FLG38505Medicare UPIN
32204Medicare ID - Type Unspecified