1154613982 NPI number — JOSHUA DAVID AUSTIN PA-C

Table of content: JOSHUA DAVID AUSTIN PA-C (NPI 1154613982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154613982 NPI number — JOSHUA DAVID AUSTIN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
JOSHUA
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1154613982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37930-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-314-8115
Provider Business Mailing Address Fax Number:
865-692-2352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-5088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-548-4119
Provider Business Practice Location Address Fax Number:
931-552-0999
Provider Enumeration Date:
05/12/2011

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: 363A00000X , with the licence number:  1982 , 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)