Healthcare Provider Details

I. General information

NPI: 1114969656
Provider Name (Legal Business Name): MR. MARCUS DONALD FINCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PARKWAY LN STE 10
PETAL MS
39465-3035
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-7404
  • Fax: 601-544-1646
Mailing address:
  • Phone: 601-928-4412
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00003
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: