Healthcare Provider Details

I. General information

NPI: 1942279021
Provider Name (Legal Business Name): JOHN B HOPKINS P.H.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 HWY 45 BYPASS
JACKSON TN
38305-3618
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0348
  • Fax: 731-422-0240
Mailing address:
  • Phone: 731-425-5752
  • Fax: 731-422-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP1387
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1387
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: