Provider Demographics
NPI:1790705341
Name:THURMAN, JOHN W (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:THURMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 REDBUSH CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4340
Mailing Address - Country:US
Mailing Address - Phone:423-283-4958
Mailing Address - Fax:423-283-7135
Practice Address - Street 1:1633 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4115
Practice Address - Country:US
Practice Address - Phone:423-282-1480
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3983164Medicaid
TN3983164Medicaid
TN3983164Medicare ID - Type Unspecified