Provider Demographics
NPI:1285676999
Name:MARSHALL, JOHN WILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIS
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:580 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5463
Mailing Address - Country:US
Mailing Address - Phone:423-902-7737
Mailing Address - Fax:
Practice Address - Street 1:2333 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3258
Practice Address - Country:US
Practice Address - Phone:423-493-1493
Practice Address - Fax:423-698-6061
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30691207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000818364KMedicaid
TN3836151Medicaid
TN3836151Medicaid