Individual
MR. JUSTIN LUKE BOREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
832 WESTOVER DR STE 200, COLUMBIA, TN 38401-4843
(931) 830-3033
(931) 388-3401
Mailing address
410 42ND AVE N STE 400, NASHVILLE, TN 37209-3658
(615) 329-7887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1296
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009941922
—
AL
01
—
4142242
BLUE CROSS
TN
05
—
874485289A
—
GA
05
—
874485289B
—
GA
01
—
P00382564
RAILROAD MEDICARE
TN
Enumeration date
01/04/2007
Last updated
08/15/2023
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