Provider Demographics
NPI:1992528764
Name:MARABLE, JARRELL DEMONT
Entity type:Individual
Prefix:MR
First Name:JARRELL
Middle Name:DEMONT
Last Name:MARABLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5888
Mailing Address - Country:US
Mailing Address - Phone:615-275-8987
Mailing Address - Fax:
Practice Address - Street 1:5106 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5888
Practice Address - Country:US
Practice Address - Phone:615-275-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN057372711172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver