Provider Demographics
NPI:1598716821
Name:JAMES, TINA C (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:C
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:C
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1826 LAGONDA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-3918
Mailing Address - Country:US
Mailing Address - Phone:502-505-9060
Mailing Address - Fax:
Practice Address - Street 1:1826 LAGONDA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3918
Practice Address - Country:US
Practice Address - Phone:502-505-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY346242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH40942Medicare UPIN
KY3402730Medicare ID - Type Unspecified