Provider Demographics
NPI:1982608675
Name:MCCAULEY, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCCAULEY
Suffix:
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 1:2500 JACKSBORO PIKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2818
Mailing Address - Country:US
Mailing Address - Phone:423-907-1685
Mailing Address - Fax:423-907-1688
Practice Address - Street 1:2500 JACKSBORO PIKE
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2818
Practice Address - Country:US
Practice Address - Phone:423-907-1685
Practice Address - Fax:423-907-1688
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34809207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3866041Medicaid
TN3866041Medicaid
TN103I161284Medicare PIN