Healthcare Provider Details

I. General information

NPI: 1245694231
Provider Name (Legal Business Name): DIAHANN MARSHALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 4TH ST STE A
ALEXANDRIA LA
71301-8411
US

IV. Provider business mailing address

PO BOX 735328
DALLAS TX
75373-5328
US

V. Phone/Fax

Practice location:
  • Phone: 318-441-1041
  • Fax: 318-441-1050
Mailing address:
  • Phone: 318-441-1041
  • Fax: 318-441-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS2838
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333177
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: