Basic Information
| Provider Information | |||||||||
| NPI: | 1164465738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRITTENDEN | ||||||||
| FirstName: | MARCUS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 BURTON HILLS BLVD | ||||||||
| Address2: | STE 175 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159882014 | ||||||||
| FaxNumber: | 6155230647 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397052008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048051300 | ||||||||
| FaxNumber: | 9048051302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 13887 | MS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 73104186 | 01 | MS | ALABAMA BLUE CROSS | OTHER | 00113884 | 05 | MS | MEDICAID | 009983275 | 01 | MS | ALABAMA MEDICAID | OTHER | 562251777 | 01 | MS | BLUE CROSS | OTHER | P00233502 | 01 | MS | RAILROAD MEDICARE | OTHER |