Provider Demographics
NPI:1013095603
Name:JOHN, THOMAS MICHAEL (M D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:JOHN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MURFREESBORO RD STE 319
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1312
Mailing Address - Country:US
Mailing Address - Phone:615-790-0567
Mailing Address - Fax:615-595-8030
Practice Address - Street 1:1113 MURFREESBORO RD STE 319
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1312
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:615-595-8030
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017835207Q00000X, 207QS0010X
TNMD46742207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522028Medicaid
TN46742OtherTN LIC NUMBER
LAMD.017835OtherLOUISIANA MEDICAL LICENSE
FLME97701OtherFLORIDA MED LICENSE
FL2774721-00Medicaid
FL93413OtherBCBSFL
FL93413OtherBCBSFL
LAAJ2865105OtherDEA NUMBER
TN1522028Medicaid
FL93413OtherBCBSFL
FLME97701OtherFLORIDA MED LICENSE