Healthcare Provider Details

I. General information

NPI: 1740983857
Provider Name (Legal Business Name): FAHAD MARMARCHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

PO BOX 1190
LAWRENCEVILLE GA
30046-1190
US

V. Phone/Fax

Practice location:
  • Phone: 228-809-5000
  • Fax:
Mailing address:
  • Phone: 678-772-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37341
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: