Clarice Dewitt Marty, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

GA 799 Issued in GA

Practice address

300 W Hospital Road
Eisenhower Army Medical Center Attn Credentials
Fort Gordon, GA 30905-5650

Phone

(706) 787-2720

Fax

(706) 787-8176

NPI assigned

Apr 29, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1508031550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL ROAD",
            "address_2": "EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-2720",
            "fax_number": "706-787-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL ROAD",
            "address_2": "EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055650",
            "telephone_number": "706-787-2720",
            "fax_number": "706-787-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTY",
        "first_name": "CLARICE",
        "middle_name": "DEWITT",
        "name_prefix": "Mrs.",
        "credential": "LPTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "GA 799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Marie Marek, M.A., CCC-SLP
• Jennifer E. Markyna, LCSW
• Gordon Andrew Marshall, PHYSICIAN ASSISTANT
• Eric David Martin, D.O.
• Brendan Martino, DO
• Mauricio Masferrer, M.D.
• Robert Mathis, MSW
• Anne-Marie May, BSN
• John William McCann, DDS
• Cedric F McCord, MD

• Physical Therapy Assistant in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.