Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 48121 | TN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 48121 | TN |
NPI | 1134114333 |
---|---|
Provider Name | Dr. Jeffrey Alan Marchessault |
First Address | Kingsport, TN 37660-5904 |
Second Address | Kingsport, TN 37660-5904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 14/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134114333 | (05) | VA |
1528664 | (05) | TN |
48121 | LICENSE (01) | TN |