Provider Demographics
NPI:1982236949
Name:BYRGE, JOHNNY M
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:M
Last Name:BYRGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3962
Mailing Address - Country:US
Mailing Address - Phone:423-494-9570
Mailing Address - Fax:
Practice Address - Street 1:1005 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3962
Practice Address - Country:US
Practice Address - Phone:423-494-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider