MEDICARE: DR. MARK ELLIOTT ANDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720721715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ELLIOTT ANDERSON MD

Provider Business Mailing Address
First Line	:	250 WILSHIRE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5548
Country	:	US
Telephone Number	:	931-510-6480
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 WILSHIRE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5548
Country	:	US
Telephone Number	:	931-510-6480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	12/19/2025

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