Individual
JOHN R HEREFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2002 BROOKSIDE DR STE 300, KINGSPORT, TN 37660-4634
(423) 530-7900
(423) 530-7901
Mailing address
PO BOX 3889, JOHNSON CITY, TN 37602-3889
(423) 530-7900
(423) 530-7901
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD15919
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619931557
—
VA
05
—
3011101
—
TN
05
—
3011104
—
TN
05
—
7100045670
—
KY
Enumeration date
04/17/2006
Last updated
03/31/2021
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