Provider Demographics
NPI:1831205160
Name:REYNOLDS, JOHN M IV (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:REYNOLDS
Suffix:IV
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:1819 W CLINCH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2435
Practice Address - Country:US
Practice Address - Phone:865-524-5365
Practice Address - Fax:865-673-8007
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35460207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867875Medicaid
3867876Medicare PIN
TN3867875Medicaid
3867875Medicare PIN
H47358Medicare UPIN
TN0677340003Medicare NSC