Healthcare Provider Details

I. General information

NPI: 1225958887
Provider Name (Legal Business Name): MARCUS MAURICE DRYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 RESTER RD LOT H
THEODORE AL
36582-3920
US

IV. Provider business mailing address

7272 THEODORE DAWES RD STE C
THEODORE AL
36582-4136
US

V. Phone/Fax

Practice location:
  • Phone: 855-543-7937
  • Fax: 855-543-7937
Mailing address:
  • Phone: 855-543-7937
  • Fax: 855-543-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: