Provider Demographics
NPI:1740771344
Name:OWENS, JUSTON
Entity Type:Individual
Prefix:DR
First Name:JUSTON
Middle Name:
Last Name:OWENS
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 1:1 MEDICAL PARK BLVD STE 200E
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7459
Mailing Address - Country:US
Mailing Address - Phone:423-844-5100
Mailing Address - Fax:423-844-5109
Practice Address - Street 1:1 MEDICAL PARK BLVD STE 200E
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7459
Practice Address - Country:US
Practice Address - Phone:423-844-5100
Practice Address - Fax:423-844-5109
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207525207R00000X
390200000X
TN4427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program