Provider Demographics
NPI:1992772206
Name:ALDEN, JOHN DALE III (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DALE
Last Name:ALDEN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 TROTWOOD AVE
Mailing Address - Street 2:10
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4750
Mailing Address - Country:US
Mailing Address - Phone:615-351-3987
Mailing Address - Fax:931-380-0058
Practice Address - Street 1:1324 TROTWOOD AVE
Practice Address - Street 2:10
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4750
Practice Address - Country:US
Practice Address - Phone:615-351-3987
Practice Address - Fax:931-380-0058
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1725103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684863Medicare ID - Type UnspecifiedPROVIDER NUMBER