Individual
MARK WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
228 W 4TH ST, SUITE 200, COOKEVILLE, TN 38501-2488
(931) 372-0405
(931) 372-0463
Mailing address
228 W 4TH ST, SUITE 200, COOKEVILLE, TN 38501-2488
(931) 372-0405
(931) 372-0463
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23921
TN
207RC0000X
Cardiovascular Disease Physician
23921
TN
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
23921
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1509597
—
TN
01
—
4288686
BCBS
TN
Enumeration date
09/22/2006
Last updated
06/17/2022
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