Provider Demographics
NPI:1073518734
Name:FAULKNER, MARQUETTA LARNEITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARQUETTA
Middle Name:LARNEITA
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 DR. D. B. TODD JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3599
Mailing Address - Country:US
Mailing Address - Phone:615-327-5539
Mailing Address - Fax:615-327-5813
Practice Address - Street 1:1005 DR. D. B. TODD JR. BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3599
Practice Address - Country:US
Practice Address - Phone:615-327-5539
Practice Address - Fax:615-327-5813
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13641207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3049017Medicaid
TNE58476Medicare UPIN
TN3049013Medicare ID - Type Unspecified