Provider Demographics
NPI:1093837346
Name:DOUGLAS, JOHN ELWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELWOOD
Last Name:DOUGLAS
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 1:174 MCAFEE BLF
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4067
Mailing Address - Country:US
Mailing Address - Phone:423-283-0411
Mailing Address - Fax:
Practice Address - Street 1:174 MCAFEE BLF
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-4067
Practice Address - Country:US
Practice Address - Phone:423-283-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012866207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease