Healthcare Provider Details

I. General information

NPI: 1992772206
Provider Name (Legal Business Name): JOHN DALE ALDEN III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 TROTWOOD AVE 10
COLUMBIA TN
38401-4750
US

IV. Provider business mailing address

1324 TROTWOOD AVE 10
COLUMBIA TN
38401-4750
US

V. Phone/Fax

Practice location:
  • Phone: 615-351-3987
  • Fax: 931-380-0058
Mailing address:
  • Phone: 615-351-3987
  • Fax: 931-380-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP1725
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP1725
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: