Individual
MR. JUSTIN MARCUS FENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R-NP
Contact information
Practice address
1400 PETERSON AVE N, SUITE C, DOUGLAS, GA 31533-2832
(912) 384-4000
(912) 384-4029
Mailing address
102 NW BOWENS MILL ROAD, DOUGLAS, GA 31533-2252
(912) 384-3838
(912) 384-4029
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN 194077
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003128519F
—
GA
Enumeration date
09/14/2012
Last updated
12/02/2016
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