Healthcare Provider Details

I. General information

NPI: 1811994981
Provider Name (Legal Business Name): JOHN RICHARD HOVIOUS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MEADOW VIEW ROAD SUITE 7
BRISTOL TN
37620-1661
US

IV. Provider business mailing address

109 MEADOW VIEW ROAD SUITE 7
BRISTOL TN
37620-1661
US

V. Phone/Fax

Practice location:
  • Phone: 423-652-1655
  • Fax: 423-652-7668
Mailing address:
  • Phone: 423-652-1655
  • Fax: 423-652-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0000013744
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: