MEDICARE: SARAH MARSHALL MANTLE MD

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	208000000X	Pediatrics Physician	45131	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	:	1407903362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARSHALL MANTLE MD

Provider Business Mailing Address
First Line	:	200 GLEAVES ST
Second Line	:	SUITE A
City	:	MADISON
State	:	TN
Zip	:	37115-2154
Country	:	US
Telephone Number	:	615-851-7865
Fax Number	:	615-851-7853

Provider Business Practice Location Address
First Line	:	200 GLEAVES ST
Second Line	:	SUITE A
City	:	MADISON
State	:	TN
Zip	:	37115-2154
Country	:	US
Telephone Number	:	615-851-7865
Fax Number	:	615-851-7853

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	02/18/2011

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