Healthcare Provider Details

I. General information

NPI: 1538166277
Provider Name (Legal Business Name): MARSHALL S. MILLMAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 MURFREESBORO HWY
MANCHESTER TN
37355-3206
US

IV. Provider business mailing address

PO BOX 299
MANCHESTER TN
37349-0299
US

V. Phone/Fax

Practice location:
  • Phone: 931-728-5607
  • Fax: 931-728-8354
Mailing address:
  • Phone: 931-728-5607
  • Fax: 931-728-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD24195
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: