Provider Demographics
NPI:1396460028
Name:NORWOOD, MARCUS D SR (PHD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:D
Last Name:NORWOOD
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12145 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5987
Mailing Address - Country:US
Mailing Address - Phone:901-825-9812
Mailing Address - Fax:
Practice Address - Street 1:6119 HAMLET RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-7458
Practice Address - Country:US
Practice Address - Phone:901-825-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104185374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN104185OtherPHD