NPIMap

Organization Active NPI

Marshes Medical Diagnostic Clinic, PC

  • Nephrology Physician
  • Brunswick, GA
National Provider Identifier
1013922699
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
MARSHES MEDICAL DIAGNOSTIC CLINIC, PC
Practice address
2705 Wildwood Dr
Brunswick, GA 31520-4346
Phone
(912) 264-6133
Fax
(912) 267-1415
NPI assigned
Jul 30, 2006
Last updated
Jun 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Andrea Page Callahan
Title
Sec/Treas
Phone
(912) 264-6133

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

2705 Wildwood Dr
Brunswick, GA 31520-4346

Mailing address

2705 Wildwood Dr
Brunswick, GA 31520-4346
Phone (912) 264-6133

Other identifiers 2

IdentifierTypeStateIssuer
CL1232OtherGARAILROAD MEDICARE
GRP 1465OtherGACAHABA MEDICARE

National Provider Directory

National Provider Directory

Locations

3025 Shrine Rd
Ste 450
Brunswick, GA 31520
Phone (912) 264-4613

104 Lakeshore Dr
Ste B
Saint Marys, GA 31558
Phone (912) 261-0080

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1013922699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 WILDWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204346",
            "telephone_number": "912-264-6133",
            "fax_number": "912-267-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 WILDWOOD DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204346",
            "telephone_number": "912-264-6133",
            "fax_number": "912-267-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHES MEDICAL DIAGNOSTIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "PAGE",
        "authorized_official_title_or_position": "SEC/TREAS",
        "authorized_official_telephone_number": "912-264-6133",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL1232",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAHABA MEDICARE",
            "identifier": "GRP 1465",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.