MEDICARE: DR. MARQUETTA LARNEITA FAULKNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	13641	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073518734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARQUETTA LARNEITA FAULKNER M.D.

Provider Business Mailing Address
First Line	:	1005 DR. D. B. TODD JR. BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-327-5539
Fax Number	:	615-327-5813

Provider Business Practice Location Address
First Line	:	1005 DR. D. B. TODD JR. BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-327-5539
Fax Number	:	615-327-5813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/23/2016

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