Provider Demographics
NPI:1295007730
Name:JUSTICE, ANTHONY GLEN (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GLEN
Last Name:JUSTICE
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 1:11911 KINGSTON PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4602
Mailing Address - Country:US
Mailing Address - Phone:865-437-7401
Mailing Address - Fax:
Practice Address - Street 1:11911 KINGSTON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-4602
Practice Address - Country:US
Practice Address - Phone:865-437-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD19281207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine