Healthcare Provider Details

I. General information

NPI: 1184078560
Provider Name (Legal Business Name): MARK HOTCHKISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 BUSINESS PARK CIR STE 100
GOODLETTSVILLE TN
37072-3189
US

IV. Provider business mailing address

3012 BUSINESS PARK CIR STE 100
GOODLETTSVILLE TN
37072-3189
US

V. Phone/Fax

Practice location:
  • Phone: 615-239-2046
  • Fax: 615-296-9925
Mailing address:
  • Phone: 615-239-2046
  • Fax: 615-296-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number61552
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: