Provider Demographics
NPI:1275539835
Name:KIRBY, JOHN AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AUSTIN
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:STE 130
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5279
Practice Address - Country:US
Practice Address - Phone:865-475-4742
Practice Address - Fax:865-262-0100
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN35319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706633OtherMEDICARE LEGACY GROUP
TNP00436759OtherRR MEDICARE PIN
TN3706633OtherMEDICARE LEGACY GROUP
TNP00436759OtherRR MEDICARE PIN