Provider Demographics
NPI:1285452870
Name:MARRS, MICHELLE TARA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TARA
Last Name:MARRS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-2311
Mailing Address - Country:US
Mailing Address - Phone:336-247-5071
Mailing Address - Fax:
Practice Address - Street 1:7 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2311
Practice Address - Country:US
Practice Address - Phone:336-247-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist