Provider Demographics
NPI:1578665188
Name:SUDBERRY, JAMES ALLEN (DPM)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:SUDBERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 306025
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6025
Mailing Address - Country:US
Mailing Address - Phone:615-425-2708
Mailing Address - Fax:615-370-0778
Practice Address - Street 1:300 STONECREST BLVD STE 255
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6837
Practice Address - Country:US
Practice Address - Phone:615-220-2982
Practice Address - Fax:615-220-2984
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000644213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111238OtherBLUE CROSS BLUE SHIELD
TNV06452Medicare UPIN
TN3354175Medicare PIN