Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ORT0000000167 | TN |
N | 222Z00000X | Podiatrist | ORT0000000167 | TN |
Y | 224P00000X | Prosthetist | PRO0000000138 | TN |
NPI | 1316236441 |
---|---|
Provider Name | John Harold Reynolds |
First Address | Knoxville, TN 37919-6205 |
Second Address | Knoxville, TN 37919-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |