Provider Demographics
NPI:1023217445
Name:TURNER, JUSTIN L (PA C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:TURNER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 S CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110
Mailing Address - Country:US
Mailing Address - Phone:931-507-2273
Mailing Address - Fax:931-507-2274
Practice Address - Street 1:1012 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-507-2273
Practice Address - Fax:931-507-2274
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375314Medicare PIN
TN3370217Medicare PIN
TN36651441Medicare PIN