Provider Demographics
NPI:1609850304
Name:GEORGE, JAMES WALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTON
Last Name:GEORGE
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:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-1087
Mailing Address - Country:US
Mailing Address - Phone:931-454-9810
Mailing Address - Fax:931-393-1020
Practice Address - Street 1:1816 N WASHINGTON ST
Practice Address - Street 2:STE 103
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2477
Practice Address - Country:US
Practice Address - Phone:931-454-9810
Practice Address - Fax:931-393-1020
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000162099207L00000X
TNMD0000016209207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4026260OtherBLUECROSS
TN50085011OtherRAILROAD MEDICARE
TN3015238Medicaid
TN3015238Medicaid
TN50085011OtherRAILROAD MEDICARE