Healthcare Provider Details

I. General information

NPI: 1710030044
Provider Name (Legal Business Name): NATHAN ANDREW MARSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST
FAIRBANKS AK
99701-5937
US

IV. Provider business mailing address

300 W HOSPITAL RD EISENHOWER ARMY MEDICAL CENTER, ATTN CREDENTIALS
AUGUSTA GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3545
  • Fax: 907-328-0474
Mailing address:
  • Phone: 706-787-2720
  • Fax: 706-787-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number58800
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number240356
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number240356
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: