Healthcare Provider Details

I. General information

NPI: 1205880093
Provider Name (Legal Business Name): MARCIA LITTLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D100
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-3580
  • Fax: 251-266-3581
Mailing address:
  • Phone: 251-633-3662
  • Fax: 251-633-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number12672
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: