Healthcare Provider Details

I. General information

NPI: 1013095603
Provider Name (Legal Business Name): THOMAS MICHAEL JOHN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MURFREESBORO RD STE 319
FRANKLIN TN
37064-1312
US

IV. Provider business mailing address

1113 MURFREESBORO RD STE 319
FRANKLIN TN
37064-1312
US

V. Phone/Fax

Practice location:
  • Phone: 615-790-0567
  • Fax: 615-595-8030
Mailing address:
  • Phone: 615-790-0567
  • Fax: 615-595-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.017835
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD.017835
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD46742
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD46742
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: