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NPI Code Detail

MEDICARE: JOHN PAUL ABNER PHD

MEDICARE: JOHN PAUL ABNER PHD
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
1103TC0700XClinical Psychologist2096TN

General Provider Information

NPI Number : 1508885138
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PAUL ABNER PHD
Provider Business Mailing Address
First Line : 112 E MYRTLE AVE
Second Line : SUITE 507
City : JOHNSON CITY
State : TN
Zip : 37601-8600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 403 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6034
Country : US
Telephone Number : 423-431-7111
Fax Number : 423-431-7092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 08/27/2019

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