Provider Demographics
NPI:1730236811
Name:DECK, MARGIE JEAN (PA-C, MPAS)
Entity type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:JEAN
Last Name:DECK
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:192 LINDQUIST ROAD
Mailing Address - Street 2:BUILDING 412
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-5451
Mailing Address - Fax:
Practice Address - Street 1:192 LINDQUIST RD
Practice Address - Street 2:BUILDING 412
Practice Address - City:FT. STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1070422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant