Individual
JOHN RANDOLPH IBANEZ III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 WHITE AVE, NASHVILLE, TN 37204-2235
(615) 460-4463
Mailing address
2400 WHITE AVE, NASHVILLE, TN 37204-2235
(615) 460-4463
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/24/2011
Last updated
06/09/2026
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