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Individual

TRISTA JACINTA MARSHALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3351 NORTHSIDE DR, MACON, GA 31210-2587
(478) 201-6500
Mailing address
3022 CASTLEWOODS DR, MACON, GA 31204-1474
(478) 361-2822

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
068927
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
068927
GA LICENSE
GA
Enumeration date
04/29/2009
Last updated
03/13/2017
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