Healthcare Provider Details

I. General information

NPI: 1851376776
Provider Name (Legal Business Name): DENNIS MICHAEL MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 WHEELER RD SUITE 201
AUGUSTA GA
30909-6446
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-3035
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-0061
  • Fax: 706-650-0064
Mailing address:
  • Phone: 706-650-0061
  • Fax: 706-650-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD19274
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number038552
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD19274
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number038552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: