Fairhurst Dermatology

NPI 1114010741 - Specialist - 174400000X

NPI Details
NPI 1114010741
Enumeration Date 10/02/2006
Last Updated 03/19/2013
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name MARK VICTOR MARK
Position PRESIDENT/OWNER
Phone (615) 870-1404
Fax (615) 870-1454
Practice Location
3040 BUSINESS PARK CIR
GOODLETTSVILLE TN, 37072-3594, US
Phone (615) 870-1404
Fax (615) 870-1454
Business Location
3040 BUSINESS PARK CIR
GOODLETTSVILLE TN, 37072-3594, US
Phone (615) 870-1404
Fax (615) 870-1454
Toxanomy
Taxonomy Code 174400000X
License State Tennessee
License Number 36190
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According to our database, Fairhurst Dermatology NPI is 1114010741, taxonomy code is 174400000X and license number is 36190, license state is located at Tennessee. Fairhurst Dermatology physically located at 3040 Business Park Cir, Goodlettsville TN, 37072-3594. NPI Number 1033115704 has the healthcare provider type.

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1114010741 NPI number is provided on an as is basis without warranty of any kind. 1114010741 is maintained by the National Plan & Provider Enumeration System. The contents of Fairhurst Dermatology are for informational purposes only.