Provider Demographics
NPI:1952171647
Name:ANDERSON, MARCUS RAY'SHAWN JR
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:RAY'SHAWN
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 GLENRIDGE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1601
Mailing Address - Country:US
Mailing Address - Phone:404-906-9377
Mailing Address - Fax:
Practice Address - Street 1:5533 GLENRIDGE DR APT 3
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1601
Practice Address - Country:US
Practice Address - Phone:404-906-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker