Provider Demographics
NPI:1508961996
Name:AMLICKE, JAMES DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:AMLICKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:DAVID
Other - Last Name:AMLICKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:311 LANDRUM PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-648-3563
Mailing Address - Fax:931-648-8133
Practice Address - Street 1:311 LANDRUM PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-648-3563
Practice Address - Fax:931-648-8133
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN24102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839672Medicaid
TN38396711Medicaid
TN4157789OtherBCBS
TN3839672Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B
TNP00620991Medicare PIN
TN3839672Medicaid
TN38396711Medicare PIN