Healthcare Provider Details

I. General information

NPI: 1407824295
Provider Name (Legal Business Name): AUBREY MARTIN CAWTHON JR. PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 NW ATLANTIC ST
TULLAHOMA TN
37388-3504
US

IV. Provider business mailing address

112 AIRPORT BUSINESS PARK DR STE F
SHELBYVILLE TN
37160-7453
US

V. Phone/Fax

Practice location:
  • Phone: 931-393-4332
  • Fax: 931-393-2304
Mailing address:
  • Phone: 931-393-4332
  • Fax: 931-393-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: