Healthcare Provider Details

I. General information

NPI: 1841761947
Provider Name (Legal Business Name): MAC'S MEDICINE MART, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E CENTER ST STE 2B
KINGSPORT TN
37664-2501
US

IV. Provider business mailing address

1455 E CENTER ST STE 2B
KINGSPORT TN
37664-2501
US

V. Phone/Fax

Practice location:
  • Phone: 423-246-2646
  • Fax: 423-765-9111
Mailing address:
  • Phone: 423-246-2646
  • Fax: 423-765-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY WALTON
Title or Position: OWNER/PHARMACIST
Credential: DPH
Phone: 423-245-2181