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General NPI Number Information
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NPI Number | 1114969656
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Entity Type | Individual
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Provider Name | MR. MARCUS DONALD FINCH
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Gender | Male
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 50 PARKWAY LN STE 10
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City | PETAL
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State | MS
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Zip | 39465-3035
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Country | US
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Telephone | 601-544-7404
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Fax | 601-544-1646
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Provider Business Mailing Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-928-4412
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Fax | 601-579-5240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00003
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License Number State | MS
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