Provider Demographics
NPI:1437101524
Name:EBY, JAMES WILDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILDER
Last Name:EBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-855-6033
Mailing Address - Fax:615-296-9939
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0200
Practice Address - Fax:615-885-0267
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN42082208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000718Medicaid
TNI54014OtherUPIN
TN4342403OtherBCBS
TN3000718Medicare PIN
TN103I259359Medicare PIN