Healthcare Provider Details

I. General information

NPI: 1316875016
Provider Name (Legal Business Name): JOHN TYLER EARWOOD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MED TECH PKWY STE 240
JOHNSON CITY TN
37604-2641
US

IV. Provider business mailing address

PO BOX 632476
CINCINNATI OH
45263-2476
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-5520
  • Fax: 423-282-6940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7248
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: