Provider Demographics
NPI:1144425075
Name:MARSHALL, CHRISTOPHER DEAN AVERETT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DEAN AVERETT
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2972
Mailing Address - Country:US
Mailing Address - Phone:731-257-1500
Mailing Address - Fax:731-257-1501
Practice Address - Street 1:190 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2972
Practice Address - Country:US
Practice Address - Phone:731-257-1500
Practice Address - Fax:731-257-1501
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41991207QA0401X, 207Q00000X, 207QA0401X
TN42847207QA0401X, 2083A0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512800Medicaid