Provider Demographics
NPI:1235285511
Name:MARCIA J. LITTLES, M.D., P.C.
Entity type:Organization
Organization Name:MARCIA J. LITTLES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LITTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-3662
Mailing Address - Street 1:PO BOX 851387
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1387
Mailing Address - Country:US
Mailing Address - Phone:251-366-3662
Mailing Address - Fax:251-633-3660
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-6332
Practice Address - Fax:251-633-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12672207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932808Medicaid
AL529932808Medicaid