Provider Demographics
NPI:1003884412
Name:WILLIAMS, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:434 4TH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3735
Mailing Address - Country:US
Mailing Address - Phone:423-623-1022
Mailing Address - Fax:423-625-0327
Practice Address - Street 1:434 4TH ST
Practice Address - Street 2:STE 301
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3735
Practice Address - Country:US
Practice Address - Phone:423-623-1022
Practice Address - Fax:423-625-0327
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN14979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7906926Medicaid
0140268OtherUNITED HEALTHCARE
080012097OtherRAILROAD MEDICARE
TN2003654OtherBLUE CROSS
612301OtherJOHN DEERE
TN3003795Medicaid
TN3003795Medicaid
080012097OtherRAILROAD MEDICARE