Individual
JOHN G NIETHAMMER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
907 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5015
(865) 977-5567
(865) 980-4962
Mailing address
PO BOX 1445, INDIANAPOLIS, IN 46206-1445
(866) 388-2916
(855) 388-4124
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
19296
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300125495
RR MCARE
TN
05
—
3068139
—
TN
01
—
4023116
BC/BS OF TN
TN
05
—
64720816
—
SD
Enumeration date
03/29/2006
Last updated
02/02/2017
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