Weatherly, Mark W

Weatherly, Mark W is an individual health care provider with primary practice located at 7695 Poplar Pike Suite 101, Germantown TN 38138-5947. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Weatherly, Mark W can be contacted via phone (901) 685-2696.

Contact Information

Primary practice address
7695 Poplar Pike Suite 101 Germantown TN 38138-5947
Phone: (901) 685-2696
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 12841 Tennessee
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 12841 Tennessee
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 10958 Mississippi

Profile Details

NPI number 1144223553
LBN Legal business name Weatherly, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Aug 3rd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144223553 NPPES
Tennessee MEDICAID 3046111

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