Provider Demographics
NPI:1922133404
Name:GURSKI, JOHN CONRAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONRAD
Last Name:GURSKI
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 1:1606 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-9642
Mailing Address - Country:US
Mailing Address - Phone:615-595-5789
Mailing Address - Fax:615-595-5789
Practice Address - Street 1:1606 EMERALD CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-9642
Practice Address - Country:US
Practice Address - Phone:615-595-5789
Practice Address - Fax:615-595-5789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100967037OtherTIN
TN3583425Medicare ID - Type UnspecifiedHEALTHCARE PROVIDER
103I686217Medicare PIN