Healthcare Provider Details

I. General information

NPI: 1801847025
Provider Name (Legal Business Name): JOHN RICHARD JANOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 HIGHWAY 51 S SUITE 102
COVINGTON TN
38019-3635
US

IV. Provider business mailing address

5192 BLACKWELL RD
MEMPHIS TN
38134-3104
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-3424
  • Fax: 901-475-3696
Mailing address:
  • Phone: 901-476-3424
  • Fax: 901-475-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0000006167
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: