Healthcare Provider Details

I. General information

NPI: 1548303381
Provider Name (Legal Business Name): JOHN CARL HYDEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GERMANTOWN RD
GERMANTOWN TN
38138-2205
US

IV. Provider business mailing address

1400 S GERMANTOWN RD
GERMANTOWN TN
38138-2205
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-3100
  • Fax: 901-759-3196
Mailing address:
  • Phone: 901-759-3100
  • Fax: 901-759-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number43649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: