Basic Information
| Provider Information | |||||||||
| NPI: | 1013095603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 MURFREESBORO RD STE 319 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157900567 | ||||||||
| FaxNumber: | 6155958030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1113 MURFREESBORO RD STE 319 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157900567 | ||||||||
| FaxNumber: | 6155958030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD.017835 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | MD.017835 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | MD46742 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | MD46742 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1522028 | 05 | TN | MEDICAID | 46742 | 01 | TN | TN LIC NUMBER | OTHER | MD.017835 | 01 | LA | LOUISIANA MEDICAL LICENSE | OTHER | ME97701 | 01 | FL | FLORIDA MED LICENSE | OTHER | AJ2865105 | 01 | LA | DEA NUMBER | OTHER | 2774721-00 | 05 | FL | MEDICAID | 93413 | 01 | FL | BCBSFL | OTHER |