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General NPI Number Information
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NPI Number | 1679265490
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Entity Type | Individual
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Provider Name | JOHN THOMAS FUSSELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 4891 E MAIN ST
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City | ERIN
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State | TN
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Zip | 37061-4115
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Country | US
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Telephone | 931-289-4201
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Fax | 931-289-1947
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Provider Business Mailing Address
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Address Line | 50 HUNTER LN
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City | ERIN
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State | TN
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Zip | 37061-4169
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Country | US
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Telephone | 931-289-9189
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5567
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License Number State | TN
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