Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101258254 | VA |
N | 207Q00000X | Family Doctor | 50575 | MT |
Y | 207Q00000X | Family Doctor | 53134 | TN |
N | 207Q00000X | Family Doctor | MD.36816 | AL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 53134 | TN |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD.36816 | AL |
NPI | 1821331273 |
---|---|
Provider Name | Dr. Mark W. Ernest |
First Address | Johnson City, TN 37604-3307 |
Second Address | Loudon, TN 37774-1309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 01/02/2022 |