Healthcare Provider Details

I. General information

NPI: 1962667931
Provider Name (Legal Business Name): ADAM THOMAS MARLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIMOSA DR FL 2
THOMASVILLE GA
31792-6676
US

IV. Provider business mailing address

301 FISHER ST. KEESLER AFB
BILOXI MS
39534
US

V. Phone/Fax

Practice location:
  • Phone: 229-551-0083
  • Fax:
Mailing address:
  • Phone: 228-376-3728
  • Fax: 228-376-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number82420
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: