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Individual

MR. MARK W INGRAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
908 WEST NORTH 4TH ST, MORRISTOWN, TN 37813
(423) 586-4995
Mailing address
4519 MAJESTIC MAGNOLIA LANE, MORRISTOWN, TN 37814
(423) 312-8546
(423) 581-9692

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA783
TN

Other

Enumeration date
05/15/2006
Last updated
07/08/2007
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