Individual
MR. JOHN R. HENRITZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
340 STEELES RD, BRISTOL, TN 37620-9532
(423) 282-9011
(423) 282-0035
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
(423) 282-0035
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000001035
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386609410
—
VA
05
—
1517352
—
TN
01
—
PA0000001035
LICENSE
TN
Enumeration date
04/20/2006
Last updated
08/27/2021
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