Provider Demographics
NPI:1396049763
Name:STATEN, JOHN (HIS-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STATEN
Suffix:
Gender:M
Credentials:HIS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 CROMWELL RD
Mailing Address - Street 2:STE 310
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2166
Mailing Address - Country:US
Mailing Address - Phone:423-892-1225
Mailing Address - Fax:
Practice Address - Street 1:4295 CROMWELL RD
Practice Address - Street 2:STE 310
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2166
Practice Address - Country:US
Practice Address - Phone:423-892-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist