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General NPI Number Information
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NPI Number | 1902138704
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Entity Type | Individual
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Provider Name | MARCUS STOKES OTR
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Gender | Male
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 475 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7342
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Country | US
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Telephone | 864-244-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 165 KING CT
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City | EDWARDS
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State | MS
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Zip | 39066-9718
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Country | US
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Telephone | 601-218-0676
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Fax | 769-235-6763
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT005843
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License Number State | GA
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