Healthcare Provider Details

I. General information

NPI: 1790705341
Provider Name (Legal Business Name): JOHN W THURMAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 HILLVIEW DR
ELIZABETHTON TN
37643-4115
US

IV. Provider business mailing address

2 REDBUSH CT SUITE 2
JOHNSON CITY TN
37601-4340
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1480
  • Fax: 423-928-1353
Mailing address:
  • Phone: 423-283-4958
  • Fax: 423-283-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000002598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: