Provider Demographics
NPI:1184443343
Name:SLIGH, MARCUS DELANO (CPRS)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:DELANO
Last Name:SLIGH
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:MR
Other - First Name:MARCUS
Other - Middle Name:DELANO
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 ROLLINGWOOD DR BLDG 20
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3175
Mailing Address - Country:US
Mailing Address - Phone:606-215-1545
Mailing Address - Fax:
Practice Address - Street 1:92 BEASLEY BEND RD
Practice Address - Street 2:
Practice Address - City:RIDDLETON
Practice Address - State:TN
Practice Address - Zip Code:37151
Practice Address - Country:US
Practice Address - Phone:606-215-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN086289059175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist