Provider Demographics
NPI:1598713166
Name:JENNINGS, MARK OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:OLIVER
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7446 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8815
Mailing Address - Country:US
Mailing Address - Phone:423-443-3336
Mailing Address - Fax:423-464-7507
Practice Address - Street 1:1360 MACKEY BRANCH DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3225
Practice Address - Country:US
Practice Address - Phone:423-443-3336
Practice Address - Fax:423-464-7510
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN317142084P0804X
TNMD00000317142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF13077Medicare UPIN
TN3842731Medicare ID - Type Unspecified