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General NPI Number Information
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NPI Number | 1790708097
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Entity Type | Individual
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Provider Name | JOHN W FISK JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1407 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-444-6203
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Fax | 615-444-6252
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Provider Business Mailing Address
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Address Line | 1407 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-444-6203
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Fax | 615-444-6252
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12113
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 45857
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License Number State | TN
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