Provider Demographics
NPI:1871587170
Name:PIERDINOCK, MARSHA G (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:G
Last Name:PIERDINOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1970
Mailing Address - Country:US
Mailing Address - Phone:229-883-0298
Mailing Address - Fax:
Practice Address - Street 1:1009 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1903
Practice Address - Country:US
Practice Address - Phone:229-883-0298
Practice Address - Fax:229-438-7898
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF60456Medicare UPIN
511G701098Medicare PIN