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Contact Information

MARK A WHITEHEAD, PA-C
1222 TROTWOOD AVE.
STE 108
COLUMBIA, TN38401
 Phone: 931-388-8965
 Fax: 931-840-8520
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MARK A WHITEHEAD · (Male)

NPI # 1235326059
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 09/25/2007
Last updated 02/13/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 1531
  • TN License # PA0000001531
  • TN Medicaid 1501347
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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