Healthcare Provider Details

I. General information

NPI: 1609074251
Provider Name (Legal Business Name): JOHN CALVIN SNYDER JR. M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BLOUNTVILLE HWY SUITE 102
BRISTOL TN
37620-0213
US

IV. Provider business mailing address

350 BLOUNTVILLE HWY SUITE 102
BRISTOL TN
37620-0213
US

V. Phone/Fax

Practice location:
  • Phone: 423-764-4327
  • Fax: 423-764-2856
Mailing address:
  • Phone: 423-764-4327
  • Fax: 423-764-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number098
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: