Provider Demographics
NPI:1932977105
Name:MURSCH, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MURSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 KISSINGBOWER RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5443
Mailing Address - Country:US
Mailing Address - Phone:971-273-6886
Mailing Address - Fax:
Practice Address - Street 1:607 KISSINGBOWER RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5443
Practice Address - Country:US
Practice Address - Phone:971-273-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-336327106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician