Basic Information
| Provider Information | |||||||||
| NPI: | 1902138704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOKES | ||||||||
| FirstName: | MARCUS | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 KING CT | ||||||||
| Address2: | |||||||||
| City: | EDWARDS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390669718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012180676 | ||||||||
| FaxNumber: | 7692356763 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302817342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642443626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225X00000X | OT005843 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.