Individual
JOHN W MANN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 230-8206
(423) 230-8502
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101254459
VA
207R00000X
Internal Medicine Physician
053656
GA
207R00000X
Internal Medicine Physician
43439
TN
208M00000X
Hospitalist Physician
0101254459
VA
208M00000X
Hospitalist Physician
Primary
43439
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001094C
—
GA
05
—
1104811694
—
VA
05
—
1507594
—
TN
01
—
52484938
BCBSGA
—
05
—
7100058980
—
KY
Enumeration date
09/12/2005
Last updated
01/08/2014
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