Healthcare Provider Details

I. General information

NPI: 1609086214
Provider Name (Legal Business Name): MARC VINCENT COURTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 WARD AVE
LOUDON TN
37774-1323
US

IV. Provider business mailing address

616 WARD AVE
LOUDON TN
37774-1323
US

V. Phone/Fax

Practice location:
  • Phone: 865-458-5666
  • Fax: 865-458-9906
Mailing address:
  • Phone: 865-458-5666
  • Fax: 865-458-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43430
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number43430
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1503975
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: