Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD19281 | TN |
NPI | 1295007730 |
---|---|
Provider Name | Anthony Glen Justice |
First Address | Knoxville, TN 37934-4602 |
Second Address | Knoxville, TN 37934-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 30/01/2012 |