=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578689683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ELLIOTT WARD PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 06/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 695 PRESIDENT PL STE 202
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37167-5681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-269-4990
-----------------------------------------------------
Fax | 615-953-9862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 695 PRESIDENT PL STE 202
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37167-5681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-269-4990
-----------------------------------------------------
Fax | 615-953-9862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | P248
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | P248
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------