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General NPI Number Information
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NPI Number | 1295352888
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Entity Type | Individual
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Provider Name | MR. MARCUS E. WINDHOM SR.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 150 SESSIONS DR
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City | MACON
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State | GA
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Zip | 31201-2317
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Country | US
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Telephone | 404-625-5907
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Fax |
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Provider Business Mailing Address
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Address Line | 478 MONROE HL APT 310
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City | MACON
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State | GA
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Zip | 31204-6552
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Country | US
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Telephone | 404-625-5907
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | IL
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