MEDICARE: AUDIE B MARLAR JR. PA

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	207Q00000X	Family Medicine Physician	00127	TN

General Provider Information

NPI Number	:	1447254164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDIE B MARLAR JR. PA

Provider Business Mailing Address
First Line	:	117 KENNEDY DR
Second Line	:
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-9511
Fax Number	:	731-587-0785

Provider Business Practice Location Address
First Line	:	117 KENNEDY DR
Second Line	:
City	:	MARTIN
State	:	TN
Zip	:	38237-3309
Country	:	US
Telephone Number	:	731-587-9511
Fax Number	:	731-587-0785

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/03/2013

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