Provider Demographics
NPI:1811140890
Name:MARSHALL, DANIEL LEE (BSS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:BSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3201
Mailing Address - Country:US
Mailing Address - Phone:276-844-6000
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:1167 SPRATLIN PARK DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6205
Practice Address - Country:US
Practice Address - Phone:423-467-3721
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator