Provider Demographics
NPI:1407824295
Name:CAWTHON, AUBREY MARTIN JR (PAC)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:MARTIN
Last Name:CAWTHON
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 AIRPORT BUSINESS PARK DR
Mailing Address - Street 2:STE F
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7453
Mailing Address - Country:US
Mailing Address - Phone:931-393-4332
Mailing Address - Fax:931-393-2304
Practice Address - Street 1:507 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3504
Practice Address - Country:US
Practice Address - Phone:931-393-4332
Practice Address - Fax:931-393-2304
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687879Medicaid
TN4044694OtherBCBS
TNP64373Medicare UPIN
TN3687879Medicaid