1801915871 NPI number — DR. MARLENE ZETZER SHIVERS M.D.

Table of content: DR. MARLENE ZETZER SHIVERS M.D. (NPI 1801915871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801915871 NPI number — DR. MARLENE ZETZER SHIVERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIVERS
Provider First Name:
MARLENE
Provider Middle Name:
ZETZER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZETZER
Provider Other First Name:
MARLENE
Provider Other Middle Name:
JUDITH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801915871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 N HARRINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST SIMONS ISLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31522-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-634-1753
Provider Business Mailing Address Fax Number:
912-634-0959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 PARKWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-466-2495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  33236 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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