Healthcare Provider Details

I. General information

NPI: 1740285063
Provider Name (Legal Business Name): JEFFREY BLAINE MARVEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

IV. Provider business mailing address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-2005
  • Fax: 931-455-4450
Mailing address:
  • Phone: 931-455-2005
  • Fax: 931-455-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29420
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number87585
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: