Individual
MARSHALL J BOULDIN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 RIVER OAKS DR, SUITE 302, JACKSON, MS 39232-9530
(601) 939-9923
(601) 939-9924
Mailing address
3322 W END AVE, 11TH FLOOR, NASHVILLE, TN 37203-1031
(615) 515-9880
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12970
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120235
—
MS
01
—
RR 110204015
RAILROAD
MS
Enumeration date
07/08/2006
Last updated
03/09/2014
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