Provider Demographics
NPI:1790905974
Name:NETTERVILLE, JOHN T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:NETTERVILLE
Suffix:JR
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:THE ATTENTION & BEHAVIOR CLINIC
Mailing Address - Street 2:2001 MALLORY LANE STE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8236
Mailing Address - Country:US
Mailing Address - Phone:615-778-0888
Mailing Address - Fax:615-771-6916
Practice Address - Street 1:THE ATTENTION & BEHAVIOR CLINIC
Practice Address - Street 2:2001 MALLORY LANE STE 300
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8236
Practice Address - Country:US
Practice Address - Phone:615-778-0888
Practice Address - Fax:615-771-6916
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110542080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD11054OtherMEDICAL LICENSE NUMBER
TND32171Medicare UPIN