Healthcare Provider Details

I. General information

NPI: 1154362101
Provider Name (Legal Business Name): MARK B HELLMANN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 TANNER WAY STE 130
HARRIMAN TN
37748-8331
US

IV. Provider business mailing address

1855 TANNER WAY STE 130
HARRIMAN TN
37748-8331
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-4944
  • Fax:
Mailing address:
  • Phone: 865-882-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDPM608
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE P SHARP
Title or Position: BILLING MANAGER
Credential:
Phone: 615-563-2010