Provider Demographics
NPI:1023029865
Name:GHOLSON, JOHN A III (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:GHOLSON
Suffix:III
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DONELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2926
Mailing Address - Country:US
Mailing Address - Phone:615-889-7111
Mailing Address - Fax:615-889-6717
Practice Address - Street 1:130 DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2926
Practice Address - Country:US
Practice Address - Phone:615-889-7111
Practice Address - Fax:615-889-6717
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 14921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007322OtherBCBS
TN0543098OtherUNITED CONCORDIA