Provider Demographics
NPI:1497835334
Name:LEACH, JAMES WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WENDELL
Last Name:LEACH
Suffix:
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 1:842 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3528
Mailing Address - Country:US
Mailing Address - Phone:931-388-5104
Mailing Address - Fax:931-840-6266
Practice Address - Street 1:810 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1309
Practice Address - Country:US
Practice Address - Phone:865-657-9303
Practice Address - Fax:865-657-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9419174400000X
TN9419207V00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2009778OtherBCBS
TN10067723Medicaid
TNQ009993Medicaid