Demetri W Marshall, M.D.
Individual provider Active NPI Family Medicine Physician · Port Gibson, MS
NPI 1740385103 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1740385103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 10558 (MS)
- Practice address
- 2045 Highway 61 North
Port Gibson, MS 39150-4262 - Phone
- (601) 437-3050
- Fax
- (601) 437-3051
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10558 | MS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Claiborne County Family Health Center, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10558 | MS | Yes |
Addresses
Primary practice location
2045 Highway 61 North
Port Gibson, MS 39150-4262
Mailing address
P. O. Box 741
Port Gibson, MS 39150-4262
Phone (601) 437-3050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0017759 | Medicaid | MS |
Other providers in Port Gibson, MS
- Dorothy Jeanette Jones
- Charlene Davis King
- Kings Psychiatric Services LLC
- Stuart P Leventhal
- Annette Jeannie Louis
- Mississippi State Department of Health
- Denisha Taheema Moore
- Kendrique Morgan
- Za'Hara Nash
- Nikki N Neal
All providers in Port Gibson, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.