Provider Demographics
NPI:1457594947
Name:THORNHILL, JOSH EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:EDWARD
Last Name:THORNHILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4065
Mailing Address - Country:US
Mailing Address - Phone:615-382-5204
Mailing Address - Fax:615-382-4952
Practice Address - Street 1:501 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4065
Practice Address - Country:US
Practice Address - Phone:615-382-5204
Practice Address - Fax:615-382-4952
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC37626097Medicare PIN