Healthcare Provider Details

I. General information

NPI: 1063449007
Provider Name (Legal Business Name): JOHN W VINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 US HIGHWAY 64
ADAMSVILLE TN
38310-4078
US

IV. Provider business mailing address

345 US HIGHWAY 64
ADAMSVILLE TN
38310-4078
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-3383
  • Fax: 731-632-3762
Mailing address:
  • Phone: 731-632-3383
  • Fax: 731-632-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29859
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: