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General NPI Number Information
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NPI Number | 1629063995
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Entity Type | Organization
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Legal Business Name | JOHN OVERHOLT MD PLLC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 400 SUGARTREE LN SUITE 100
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City | FRANKLIN
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State | TN
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Zip | 37064-3071
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Country | US
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Telephone | 615-595-6673
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Fax | 615-591-3204
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Provider Business Mailing Address
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Address Line | 6701 BAUM DR SUITE 140
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City | KNOXVILLE
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State | TN
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Zip | 37919-7360
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Country | US
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Telephone | 865-584-5727
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Fax | 865-450-9904
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. TINA G MCGINNIS
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Credential |
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Telephone | 865-584-5727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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