Healthcare Provider Details

I. General information

NPI: 1265349849
Provider Name (Legal Business Name): JUSTIN DUGGAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 FOREST ACRES DR
JOHNSON CITY TN
37604-7167
US

IV. Provider business mailing address

2203 FOREST ACRES DR
JOHNSON CITY TN
37604-7167
US

V. Phone/Fax

Practice location:
  • Phone: 901-834-2200
  • Fax:
Mailing address:
  • Phone: 901-834-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number228664
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number228664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: