Individual
MARK A. WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1222 TROTWOOD AVE., STE 108, COLUMBIA, TN 38401
(931) 388-8965
(931) 840-8520
Mailing address
326 N LOCUST AVE, STE B, LAWRENCEBURG, TN 38464-3516
(931) 762-9797
(931) 762-9798
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
PA0000001531
TN
363A00000X
Physician Assistant
1531
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1501347
—
TN
Enumeration date
09/25/2007
Last updated
02/13/2017
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