Provider Demographics
NPI:1477743250
Name:H. JAMES WIESMAN , JR, M.D.
Entity Type:Organization
Organization Name:H. JAMES WIESMAN , JR, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-388-3104
Mailing Address - Street 1:1412 TROTWOOD AVE STE 82
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4982
Mailing Address - Country:US
Mailing Address - Phone:931-388-3104
Mailing Address - Fax:931-381-1096
Practice Address - Street 1:1412 TROTWOOD AVE STE 82
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4982
Practice Address - Country:US
Practice Address - Phone:931-388-3104
Practice Address - Fax:931-381-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD010397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5914450001Medicare NSC
TN3388679Medicare PIN