Healthcare Provider Details

I. General information

NPI: 1407837891
Provider Name (Legal Business Name): MARK THOMAS SIMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 HIXSON PIKE SUITE 102
HIXSON TN
37343-5039
US

IV. Provider business mailing address

4513 HIXSON PIKE STE 102
HIXSON TN
37343-5039
US

V. Phone/Fax

Practice location:
  • Phone: 423-298-7071
  • Fax: 423-877-7901
Mailing address:
  • Phone: 423-298-7071
  • Fax: 423-698-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19467
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: