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General NPI Number Information
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NPI Number | 1932121324
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Entity Type | Individual
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Provider Name | MARK OVERBAY MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 308 8TH ST
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City | BRISTOL
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State | TN
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Zip | 37620-2386
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Country | US
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Telephone | 423-844-6860
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Fax | 423-844-0613
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Provider Business Mailing Address
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Address Line | 999 EXECUTIVE PARK BLVD SUITE 201
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City | KINGSPORT
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State | TN
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Zip | 37660-4632
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Country | US
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Telephone | 423-224-3250
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Fax | 423-224-3258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD24658
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License Number State | TN
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