Healthcare Provider Details

I. General information

NPI: 1578689683
Provider Name (Legal Business Name): JOHN ELLIOTT WARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 PRESIDENT PL STE 202
SMYRNA TN
37167-5681
US

IV. Provider business mailing address

695 PRESIDENT PL STE 202
SMYRNA TN
37167-5681
US

V. Phone/Fax

Practice location:
  • Phone: 615-269-4990
  • Fax: 615-953-9862
Mailing address:
  • Phone: 615-269-4990
  • Fax: 615-953-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP248
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP248
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: