Healthcare Provider Details

I. General information

NPI: 1063642403
Provider Name (Legal Business Name): JOHN WILLIAM BEDDIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 CORNERSTONE DR STE A
PARIS TN
38242-5846
US

IV. Provider business mailing address

1035 ANDERSON DR
PARIS TN
38242-9561
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-8884
  • Fax: 731-642-8865
Mailing address:
  • Phone: 210-740-7131
  • Fax: 731-642-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number82716
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: