Healthcare Provider Details

I. General information

NPI: 1790158012
Provider Name (Legal Business Name): JOSEPH PROHASKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W MORRIS BLVD STE G
MORRISTOWN TN
37813-3866
US

IV. Provider business mailing address

1907 W MORRIS BLVD STE G
MORRISTOWN TN
37813-3866
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-0014
  • Fax: 423-318-2595
Mailing address:
  • Phone: 423-318-0014
  • Fax: 423-318-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2016-01634
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2016-01634
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD3678
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: