Healthcare Provider Details

I. General information

NPI: 1548426604
Provider Name (Legal Business Name): MARK REDDINGTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 CHAPMAN HWY SUITE 1
SEYMOUR TN
37865-5044
US

IV. Provider business mailing address

11560 CHAPMAN HWY SUITE 1
SEYMOUR TN
37865-5044
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-1914
  • Fax: 865-577-1714
Mailing address:
  • Phone: 865-577-1914
  • Fax: 865-577-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2258
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2258
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: