Healthcare Provider Details

I. General information

NPI: 1770826299
Provider Name (Legal Business Name): MR. JOHN ANTHONY GARDNER II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S MAIN ST STE 7
FRANKLIN KY
42134-2322
US

IV. Provider business mailing address

PO BOX 21890
BELFAST ME
04915-4115
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-7246
  • Fax: 270-282-2027
Mailing address:
  • Phone: 270-745-7246
  • Fax: 270-282-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.022765
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number51044
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: