Provider Demographics
NPI:1124021407
Name:MCCOY, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MCCOY
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 1F
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:276-386-5980
Practice Address - Fax:276-386-9387
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 11894207Q00000X
VA0101028967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3173560Medicaid
VA5622255Medicaid
VA003615H81Medicare ID - Type Unspecified
0281780001Medicare PIN
B03603Medicare UPIN
VA003615H81Medicare PIN
TN103I086169Medicare UPIN
VAC06181Medicare PIN
TN3173560Medicaid
TN3173560Medicare ID - Type Unspecified
TN080019147Medicare PIN
0281780003Medicare PIN