Provider Demographics
NPI:1992170658
Name:JOHAN VAN JAARSVELD MD PLLC
Entity type:Organization
Organization Name:JOHAN VAN JAARSVELD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN JAARSVELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-834-9781
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-834-9781
Mailing Address - Fax:615-834-0864
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE 415
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-834-9781
Practice Address - Fax:615-834-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52609207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396024980OtherPERSONAL NPI