Provider Demographics
NPI:1760940613
Name:MARBLE CITY MEDICAL PLLC
Entity type:Organization
Organization Name:MARBLE CITY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BLACKWELL
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:386-490-2398
Mailing Address - Street 1:6010 BURNETT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:386-490-2398
Mailing Address - Fax:865-859-0326
Practice Address - Street 1:6010 BURNETT CREEK RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:864-902-3983
Practice Address - Fax:865-859-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care