Healthcare Provider Details

I. General information

NPI: 1255383204
Provider Name (Legal Business Name): MARCUS T COX PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W FARIS RD
GREENVILLE SC
29605-4255
US

IV. Provider business mailing address

950 W FARIS RD
GREENVILLE SC
29605-4255
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-3444
  • Fax: 864-255-7877
Mailing address:
  • Phone: 864-271-3444
  • Fax: 864-255-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberA907
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number907
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: