Provider Demographics
NPI:1487699146
Name:HEMPHILL, MARLA R (MD)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:R
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:R
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-1062
Mailing Address - Country:US
Mailing Address - Phone:910-603-8270
Mailing Address - Fax:
Practice Address - Street 1:711 EXECUTIVE PL FL 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-615-3333
Practice Address - Fax:910-615-9765
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-004152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931307WMedicaid