Provider Demographics
NPI:1437178787
Name:VALENTINE, JOHN D
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:VALENTINE
Suffix:
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 1:107 GLEN OAK BLVD STE 201A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3000
Mailing Address - Country:US
Mailing Address - Phone:615-757-3451
Mailing Address - Fax:615-757-3296
Practice Address - Street 1:107 GLEN OAK BLVD STE 201A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3000
Practice Address - Country:US
Practice Address - Phone:615-757-3451
Practice Address - Fax:615-757-3296
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27697208600000X
TN42430208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ059943Medicaid
TN3000357Medicaid
TNQ059943Medicaid