MEDICARE: DR. JACK MARLIN AMIE 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	208800000X	Urology Physician	014120	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518034024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MARLIN AMIE JR. M.D.

Provider Business Mailing Address
First Line	:	2418 PARKWOOD DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4721
Country	:	US
Telephone Number	:	912-264-6362
Fax Number	:	912-264-6352

Provider Business Practice Location Address
First Line	:	2418 PARKWOOD DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4721
Country	:	US
Telephone Number	:	912-264-6362
Fax Number	:	912-264-6352

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	09/19/2019

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