MEDICARE: DR. EUGENE RICHARD MARNELL JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	047800	GA
2	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	047800	GA
3	2085B0100X	Body Imaging Physician	047800	GA
4	2085N0700X	Neuroradiology Physician	047800	GA
5	2085N0904X	Nuclear Radiology Physician	047800	GA
6	2085P0229X	Pediatric Radiology Physician	047800	GA
7	2085R0202X	Diagnostic Radiology Physician	047800	GA
8	2085U0001X	Diagnostic Ultrasound Physician	047800	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1346357217	OTHER	NPI - VASCULAR RADIOLOGY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275599003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE RICHARD MARNELL JR. M.D.

Provider Business Mailing Address
First Line	:	1125 TROUPE ST
Second Line	:	P.O. BOX 3129
City	:	AUGUSTA
State	:	GA
Zip	:	30914-3129
Country	:	US
Telephone Number	:	706-737-4575
Fax Number	:	706-731-5289

Provider Business Practice Location Address
First Line	:	630 13TH ST
Second Line	:	SUITE 250
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1015
Country	:	US
Telephone Number	:	706-774-5000
Fax Number	:	706-823-5928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/31/2013

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Directions to “ DR. EUGENE RICHARD MARNELL JR. M.D.” Practice Location

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