Provider Demographics
NPI:1407163223
Name:BOLDEN, JAMES MELVIN JR (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MELVIN
Last Name:BOLDEN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 SUMMER AVE
Mailing Address - Street 2:409
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3600
Mailing Address - Country:US
Mailing Address - Phone:901-490-2636
Mailing Address - Fax:
Practice Address - Street 1:3540 SUMMER AVE
Practice Address - Street 2:409
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3600
Practice Address - Country:US
Practice Address - Phone:901-490-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000007148372500000X, 372600000X, 3747A0650X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant