Provider Demographics
NPI:1134845209
Name:JEFFERY, MARSHIDA
Entity type:Individual
Prefix:
First Name:MARSHIDA
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 MOODY PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3015
Mailing Address - Country:US
Mailing Address - Phone:800-211-7589
Mailing Address - Fax:866-853-1382
Practice Address - Street 1:2301 MOODY PKWY STE 2
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3015
Practice Address - Country:US
Practice Address - Phone:800-211-7589
Practice Address - Fax:866-853-1382
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory