Provider Demographics
NPI:1417921917
Name:HORTON, MARSHALL L (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:L
Last Name:HORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:GALEN MEDICAL GROUP
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-1030
Mailing Address - Country:US
Mailing Address - Phone:423-894-3725
Mailing Address - Fax:423-954-9019
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:S 204
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6606
Practice Address - Country:US
Practice Address - Phone:423-870-2450
Practice Address - Fax:423-877-5208
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN18622207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A99581Medicare UPIN
TN3032208Medicare ID - Type Unspecified