Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2258 | TN |
N | 2081S0010X | Sports Medicine | 2258 | TN |
N | 213ES0000X | Sports Medicine | 2258 | TN |
NPI | 1548426604 |
---|---|
Provider Name | Mark Reddington |
First Address | Seymour, TN 37865-5044 |
Second Address | Seymour, TN 37865-5044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 26/08/2014 |