Individual
JUSTIN K KWON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17 1ST ST E, STANTON, TN 38069-4426
(731) 548-2232
(731) 548-2236
Mailing address
17 1ST ST E, STANTON, TN 38069-4426
(731) 548-2232
(731) 548-2236
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2404
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2404
STATE LICENSE
TN
Enumeration date
09/17/2013
Last updated
09/26/2014
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