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General NPI Number Information
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NPI Number | 1417946419
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Entity Type | Individual
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Provider Name | JERRY MARSHALL LITTLEFIELD DO
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 550 REDMOND RD NW
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City | ROME
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State | GA
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Zip | 30165-1416
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Country | US
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Telephone | 706-233-8504
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Fax | 706-233-8505
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Provider Business Mailing Address
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Address Line | 1825 MARTHA BERRY BLVD NW
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City | ROME
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State | GA
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Zip | 30165-1625
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Country | US
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Telephone | 706-295-5331
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 058624
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License Number State | GA
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