Healthcare Provider Details

I. General information

NPI: 1215277728
Provider Name (Legal Business Name): MARK A WATSON CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 STATE ST
NASHVILLE TN
37203-2929
US

IV. Provider business mailing address

1707 STATE ST
NASHVILLE TN
37203-2929
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-2882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT0000000069
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPRO0000000058
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: