Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 41991 | KY |
Y | 207Q00000X | Family Doctor | 42847 | TN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 41991 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 42847 | TN |
NPI | 1144425075 |
---|---|
Provider Name | Christopher Dean Averett Marshall |
First Address | Parsons, TN 38363-2626 |
Second Address | Parsons, TN 38363-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1512800 | (05) | TN |