=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548775042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAN JAWAD AL-GORAN DO, PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 N STATE OF FRANKLIN RD
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604-6056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-439-7280
-----------------------------------------------------
Fax | 423-439-7314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 N STATE OF FRANKLIN RD
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604-6056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-439-7280
-----------------------------------------------------
Fax | 423-439-7314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14891
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 00000
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------