Provider Demographics
NPI:1346454360
Name:JAMES SEGO DO INTERNAL MEDICINE
Entity Type:Organization
Organization Name:JAMES SEGO DO INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-472-5915
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-0294
Mailing Address - Country:US
Mailing Address - Phone:423-472-5915
Mailing Address - Fax:423-339-2321
Practice Address - Street 1:1510 STUART RD NE
Practice Address - Street 2:SUITE 106
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5858
Practice Address - Country:US
Practice Address - Phone:423-472-5915
Practice Address - Fax:423-339-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN #