Healthcare Provider Details

I. General information

NPI: 1225666902
Provider Name (Legal Business Name): ELIZABETH KAITLYN MARSHALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 HAMILL RD STE 214
HIXSON TN
37343-5098
US

IV. Provider business mailing address

1724 HAMILL RD STE 214
HIXSON TN
37343-5098
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-9022
  • Fax: 423-778-9031
Mailing address:
  • Phone: 423-778-9022
  • Fax: 423-778-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76810
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: