Provider Demographics
NPI:1972591923
Name:WITT, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:WITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3443 DICKERSON PIKE STE 580
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2526
Mailing Address - Country:US
Mailing Address - Phone:615-860-1040
Mailing Address - Fax:615-860-1242
Practice Address - Street 1:3443 DICKERSON PIKE STE 580
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2526
Practice Address - Country:US
Practice Address - Phone:615-860-1040
Practice Address - Fax:615-860-1242
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN312902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3836751Medicaid
TN3836754Medicaid
TN3836754Medicare ID - Type Unspecified