Individual
MARLYN A LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
380 HOSPITAL DR STE 370, MACON, GA 31217-8010
(478) 219-7735
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
84646
GA
2084N0400X
Neurology Physician
ME76490
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257303200
—
FL
01
—
44751
BCBS
FL
01
—
NT772
FL HF MEDICARE
FL
Enumeration date
09/07/2006
Last updated
04/14/2022
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