Provider Demographics
NPI:1306485917
Name:COALTER, JOHN CONNOR (MS, PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CONNOR
Last Name:COALTER
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 ANNAROSE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2614
Mailing Address - Country:US
Mailing Address - Phone:901-827-5498
Mailing Address - Fax:
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-381-4664
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4070363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical