Provider Demographics
NPI:1760414635
Name:HORNER, JOHN CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALVIN
Last Name:HORNER
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 1:538 W 6TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3939
Mailing Address - Country:US
Mailing Address - Phone:423-587-5283
Mailing Address - Fax:423-587-9508
Practice Address - Street 1:538 W 6TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3939
Practice Address - Country:US
Practice Address - Phone:423-587-5283
Practice Address - Fax:425-587-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN014291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3005475Medicaid
TNA97023Medicare UPIN
TN3005475Medicare ID - Type Unspecified