Basic Information
| Provider Information | |||||||||
| NPI: | 1235556937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | JOHNATHON | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9048 SUGAR ESTATE | ||||||||
| Address2: | CATH LAB | ||||||||
| City: | CHARLOTTE AMALIE | ||||||||
| State: | USVI | ||||||||
| PostalCode: | 00802 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 3407768311 | ||||||||
| FaxNumber: | 3407146310 | ||||||||
| Practice Location | |||||||||
| Address1: | 9048 SUGAR EST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE AMALIE | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008023634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407768311 | ||||||||
| FaxNumber: | 3407146310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 05GA1174 | GA | Y | Other Service Providers | Specialist |
No ID Information.