Provider Demographics
NPI:1952466989
Name:KOOMEN, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:KOOMEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 40406
Mailing Address - Street 2:CENTERSTONE ASSOC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204
Mailing Address - Country:US
Mailing Address - Phone:615-463-6600
Mailing Address - Fax:615-463-6603
Practice Address - Street 1:1600 WESTGATE CIRCLE STE 295
Practice Address - Street 2:CENTERSTONE ASSOC
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-661-4443
Practice Address - Fax:615-370-2408
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN124222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3008958Medicaid
TN3008958Medicaid
TN3008958Medicare ID - Type Unspecified