Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
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

274 MOCKINGBIRD LN APT 654
JOHNSON CITY TN
37604-3179
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-5520
  • Fax:
Mailing address:
  • Phone: 828-231-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: