Healthcare Provider Details

I. General information

NPI: 1740771344
Provider Name (Legal Business Name): JUSTON OWENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7326 MAYNARDVILLE PIKE STE 400
KNOXVILLE TN
37938-3847
US

IV. Provider business mailing address

7326 MAYNARDVILLE PIKE STE 400
KNOXVILLE TN
37938-3847
US

V. Phone/Fax

Practice location:
  • Phone: 865-925-9035
  • Fax: 865-925-9045
Mailing address:
  • Phone: 865-925-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102207525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4427
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: