Provider Demographics
NPI:1063494508
Name:JAMES, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 WILL DICKERSON RD
Mailing Address - Street 2:
Mailing Address - City:RIVES
Mailing Address - State:TN
Mailing Address - Zip Code:38253-3163
Mailing Address - Country:US
Mailing Address - Phone:731-536-1100
Mailing Address - Fax:
Practice Address - Street 1:4772 WILL DICKERSON RD
Practice Address - Street 2:
Practice Address - City:RIVES
Practice Address - State:TN
Practice Address - Zip Code:38253-3163
Practice Address - Country:US
Practice Address - Phone:731-536-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17408207R00000X
FLME79994207R00000X, 207P00000X
KY26231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4080616OtherAETNA
FL7800781OtherAETNA
TN3706440Medicaid
3000283OtherBLUE CROSS
FL91547OtherBCBS
TN3706440Medicaid
3000283OtherBLUE CROSS
4080616OtherAETNA