1407841430 NPI number — DR. JOHN PATRICK OVERHOLT MD

Table of content: DR. JOHN PATRICK OVERHOLT MD (NPI 1407841430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407841430 NPI number — DR. JOHN PATRICK OVERHOLT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERHOLT
Provider First Name:
JOHN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407841430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 BAUM DR
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-7360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-584-5727
Provider Business Mailing Address Fax Number:
865-450-9904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SUGARTREE LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37064-3071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-595-6673
Provider Business Practice Location Address Fax Number:
615-591-3204
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD30799 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 30799 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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