Basic Information
| Provider Information | |||||||||
| NPI: | 1578527677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E SWAN ST | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370331446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317293091 | ||||||||
| FaxNumber: | 9317290809 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E SWAN ST | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370331446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317293091 | ||||||||
| FaxNumber: | 9317290809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2010 | ||||||||
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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 | 207Q00000X | MD0000020592 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3052950 | 05 | TN | MEDICAID |