Provider Demographics
NPI:1043947724
Name:DRUCKENMILLER, JAMES (HIS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DRUCKENMILLER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:DRUCKENMILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7600 DEXTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8749
Mailing Address - Country:US
Mailing Address - Phone:901-301-3399
Mailing Address - Fax:
Practice Address - Street 1:4515 POPLAR AVE STE 108-B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7503
Practice Address - Country:US
Practice Address - Phone:901-767-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1024237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1024OtherH.I.S. LICENSE #