Provider Demographics
NPI:1568464519
Name:CAWTHON, ANTHONY JEROME (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JEROME
Last Name:CAWTHON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 GREYSTONE PARK
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3576
Mailing Address - Country:US
Mailing Address - Phone:731-660-3664
Mailing Address - Fax:731-660-3620
Practice Address - Street 1:2033 GREYSTONE PARK
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-660-3664
Practice Address - Fax:731-660-3620
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN529213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352865Medicaid
U72659Medicare UPIN
480026877Medicare PIN
TN3352865Medicare ID - Type Unspecified
TN3352865Medicaid