Fender, Justin Marcus

Fender, Justin Marcus is an individual health care provider with primary practice located at 1400 Peterson Ave N Suite C, Douglas GA 31533-2832. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Fender, Justin Marcus can be contacted via phone (912) 384-4000.

Contact Information

Primary practice address
1400 Peterson Ave N Suite C Douglas GA 31533-2832
Phone: (912) 384-4000
Fax: (912) 384-4029
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN 194077 Georgia

Profile Details

NPI number 1164772372
LBN Legal business name Fender, Justin Marcus
Credentials R-NP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2012
Last updated Dec 2nd, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164772372 NPPES
Georgia MEDICAID 003128519F

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