Healthcare Provider Details

I. General information

NPI: 1558327395
Provider Name (Legal Business Name): MARC A AIKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SUSANNAH ST
JOHNSON CITY TN
37601-1748
US

IV. Provider business mailing address

2410 SUSANNAH ST
JOHNSON CITY TN
37601-1748
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-9011
  • Fax: 423-282-0035
Mailing address:
  • Phone: 423-282-9011
  • Fax: 423-282-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18545
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD0000018545
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: