Provider Demographics
NPI:1205839248
Name:HOLLANDSWORTH, JAMES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:HOLLANDSWORTH
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 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:1124 FOX MEADOWS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6927
Practice Address - Country:US
Practice Address - Phone:423-239-5141
Practice Address - Fax:423-239-4869
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225081207Q00000X
NC36735207Q00000X
TNMD 26803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5643431Medicaid
TN3091340Medicaid
TN3091340Medicaid
TN0281780003Medicare PIN
TN080147573Medicare PIN
TN3091345Medicare ID - Type Unspecified
VA5643431Medicaid
TN0281780001Medicare PIN
F63204Medicare UPIN
TN103I086169Medicare UPIN