Provider Demographics
NPI:1659762391
Name:CHRISTOPHER D MARSHALL MD PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER D MARSHALL MD PLLC
Other - Org Name:CHRISTOPHER D MARSHALL MD PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEAN AVERETT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-257-1500
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:731-845-3813
Practice Address - Fax:731-257-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41991207P00000X, 207Q00000X, 207QA0401X
TN42847207P00000X, 207Q00000X, 207QA0401X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512800Medicaid
TN1512800Medicaid