Healthcare Provider Details

I. General information

NPI: 1104535624
Provider Name (Legal Business Name): JOSHUA BLAKE VIAR NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9026 HIWASSEE STREET NE
CHARLESTON TN
37310
US

IV. Provider business mailing address

9026 HIWASSEE STREET NE
CHARLESTON TN
37310
US

V. Phone/Fax

Practice location:
  • Phone: 423-665-3666
  • Fax: 423-584-6747
Mailing address:
  • Phone: 423-665-3666
  • Fax: 423-584-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32943
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32942
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: