Provider Demographics
NPI:1659770428
Name:MARK H. WAUGH, PHD, PC
Entity Type:Organization
Organization Name:MARK H. WAUGH, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-481-0180
Mailing Address - Street 1:100 HIGH POINT LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7955
Mailing Address - Country:US
Mailing Address - Phone:865-481-0180
Mailing Address - Fax:865-483-4166
Practice Address - Street 1:100 HIGH POINT LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7955
Practice Address - Country:US
Practice Address - Phone:865-481-0180
Practice Address - Fax:865-483-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1094261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)