Provider Demographics
NPI:1336037571
Name:COOMBS, JOHN TIMOTHY JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:COOMBS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 FIREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-7301
Mailing Address - Country:US
Mailing Address - Phone:865-258-2902
Mailing Address - Fax:
Practice Address - Street 1:127 FIREWOOD LN
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-7301
Practice Address - Country:US
Practice Address - Phone:865-213-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0492001171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications