Healthcare Provider Details

I. General information

NPI: 1659762391
Provider Name (Legal Business Name): CHRISTOPHER D MARSHALL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 UNIVERSITY AVE
PARSONS TN
38363-2972
US

IV. Provider business mailing address

190 UNIVERSITY AVE
PARSONS TN
38363-2972
US

V. Phone/Fax

Practice location:
  • Phone: 731-845-3813
  • Fax: 731-257-1501
Mailing address:
  • Phone: 731-257-1500
  • Fax: 731-257-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41991
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42847
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42847
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41991
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number41991
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number42847
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DEAN AVERETT MARSHALL
Title or Position: CEO
Credential: MD
Phone: 731-257-1500