Healthcare Provider Details

I. General information

NPI: 1336125285
Provider Name (Legal Business Name): MARCUS E MEEKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W FOREST AVE
JACKSON TN
38301-3942
US

IV. Provider business mailing address

810 W FOREST AVE
JACKSON TN
38301-3942
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-1853
  • Fax: 731-664-7731
Mailing address:
  • Phone: 731-668-1853
  • Fax: 731-664-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10978
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA98953
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number43477
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: