Individual
MARK ALEXANDER WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAED, ATC, LAT
Contact information
Practice address
325 CHERRY AVE, MC KENZIE, TN 38201-1769
(731) 352-4000
Mailing address
325 CHERRY AVE, MC KENZIE, TN 38201-1769
(731) 445-7413
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
476
TN
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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