Basic Information
| Provider Information | |||||||||
| NPI: | 1447565635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | PRINGLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 407 | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304750407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125374986 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304744770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125388484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2010 | ||||||||
| LastUpdateDate: | 08/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | TRN12828 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | ME112455 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 68957 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 003130830A | 05 | GA | MEDICAID |