Provider Demographics
NPI:1245213909
Name:CARMACK, JAMES H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:CARMACK
Suffix:JR
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 1:105 GLEN OAK BLVD
Mailing Address - Street 2:SUITE 199
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6424
Mailing Address - Country:US
Mailing Address - Phone:615-822-6701
Mailing Address - Fax:615-264-3310
Practice Address - Street 1:105 GLEN OAK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6424
Practice Address - Country:US
Practice Address - Phone:615-822-6701
Practice Address - Fax:615-264-3310
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159356Medicaid
TN1245213909OtherNPI
TN3159356Medicare PIN
TN1245213909OtherNPI