Provider Demographics
NPI:1518108786
Name:JOHN JASON JAMES, DO, LLC
Entity Type:Organization
Organization Name:JOHN JASON JAMES, DO, LLC
Other - Org Name:SANGO INTERNAL MEDICINE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-237-7691
Mailing Address - Street 1:662 SANGO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5978
Mailing Address - Country:US
Mailing Address - Phone:931-245-1500
Mailing Address - Fax:931-245-1544
Practice Address - Street 1:662 SANGO RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5978
Practice Address - Country:US
Practice Address - Phone:931-245-1500
Practice Address - Fax:931-245-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1628207RB0002X
TNDO 1628261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1073594099OtherDIRECTING PHYSICIAN'S INDIVIDUAL NPI
TNI13080Medicare UPIN
TN3300625Medicare PIN