Provider Demographics
NPI:1063449007
Name:VINSON, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:VINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-4078
Mailing Address - Country:US
Mailing Address - Phone:731-632-3383
Mailing Address - Fax:731-632-3762
Practice Address - Street 1:345 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-4078
Practice Address - Country:US
Practice Address - Phone:731-632-3383
Practice Address - Fax:731-632-3762
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN115572Medicaid
TN3130493OtherBLUE CROSS BLUE SHIELD S
TN3130495OtherBLUE CROSS BLUE SHIELD H
TN12104Medicaid
TN3124803OtherBLUE CROSS BLUE SHIELD A
TN3717101Medicaid
TN3124803OtherBLUE CROSS BLUE SHIELD A
930079451Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3821854Medicare ID - Type UnspecifiedADAMSVILLE
TN12104Medicaid
TN3130493OtherBLUE CROSS BLUE SHIELD S