Individual
MARIEL DANITA HEPBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 E WASHINGTON AVE, ASHBURN, GA 31714-5315
(229) 567-3407
(229) 567-4467
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
074668
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2012
Last updated
03/08/2021
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