Provider Demographics
NPI:1477949873
Name:BEVERIDGE, MARK STOCKTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STOCKTON
Last Name:BEVERIDGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ATHENS WAY # 240
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1311
Mailing Address - Country:US
Mailing Address - Phone:833-208-7770
Mailing Address - Fax:
Practice Address - Street 1:220 ATHENS WAY # 240
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1311
Practice Address - Country:US
Practice Address - Phone:833-208-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7172207LH0002X, 2080H0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391078803Medicaid