John R Holancin, MD – General Practice Physician

Key facts

NPI: 1528035797
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Physician 208D00000X
License: MD11195 (TN)
Practice address: 132 Hospital Dr
MC Kenzie, TN 38201-1637
Phone: (731) 352-7435
Fax: (731) 352-0573
NPI assigned: Mar 7, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Jackson Clinic PA Durable Medical Equipment & Medical Supplies · Jackson, TN · NPI 1689443038

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
11195	TN	MD	General Practice Dentistry
MD11195	TN	MD	General Practice Physician

Practice roles

Organization	Specialty	Status	New patients
Jackson Clinic PA	General Practice	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Physician	208D00000X	MD11195	TN	Yes

Addresses

Primary practice location

132 Hospital Dr
MC Kenzie, TN 38201-1637

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 423-8697

Other identifiers

Identifier	Type	State	Issuer
3165810	Medicaid	TN

Other providers in MC Kenzie, TN

Joseph Robert Hames, MD
Lacee Marie Harris, PMHNP
Joyce R Hayes, DPH
Brady Ray Heath, PA
Henry County Orthopaedic Surgery & Sports Medicine, PC
Lori B Holladay, FNP-BC
David Matthew Holsinger, ATC,LAT
Home Medical Products, Inc
Laura Alessandra Horner, ATC, LAT
Francis Howe

All providers in MC Kenzie, TN · General Practice Physician in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.