Provider Demographics
NPI:1578524740
Name:BELITZ, JOHN CONARD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONARD
Last Name:BELITZ
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2057
Mailing Address - Country:US
Mailing Address - Phone:865-376-6272
Mailing Address - Fax:865-376-0341
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2057
Practice Address - Country:US
Practice Address - Phone:865-376-6272
Practice Address - Fax:865-376-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN039463208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3069138OtherRAILROAD MEDICARE
TN3069138Medicaid
TNQ066118Medicaid
TN3069138Medicare PIN