Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 057542 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 043149 | KS |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 057542 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | L9339 | TX |
N | 207NS0135X | Procedural Dermatology | 057542 | GA |
NPI | 1255300976 |
---|---|
Provider Name | Steven Mitchell Marcet |
First Address | Newnan, GA 30263 |
Second Address | Newnan, GA 30263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 26/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM9305132 | DEA NUMBER (01) | |
I 38928 | (02) |