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General NPI Number Information
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NPI Number | 1306807292
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Entity Type | Individual
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Provider Name | JOHN NOVAK PA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 1224 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4802
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Country | US
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Telephone | 931-359-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 HARDWAY LN
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City | SPRING HILL
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State | TN
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Zip | 37174-5123
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Country | US
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Telephone | 440-350-1519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50000610
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1906
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License Number State | TN
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