MEDICARE: MR. JOHN QUENTIN DECKBAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386455988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN QUENTIN DECKBAR

Provider Business Mailing Address
First Line	:	2906 OAKLAND AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-5812
Country	:	US
Telephone Number	:	615-969-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 OAKLAND AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-5812
Country	:	US
Telephone Number	:	615-969-5181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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