Provider Demographics
NPI:1801847025
Name:JANOVICH, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:JANOVICH
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 1:5192 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3104
Mailing Address - Country:US
Mailing Address - Phone:901-476-3424
Mailing Address - Fax:901-475-3696
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:SUITE 102
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-476-3424
Practice Address - Fax:901-475-3696
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006167204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153325Medicaid
TN3153325Medicaid
TNB02459Medicare UPIN