Provider Demographics
NPI:1619945532
Name:WANG, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:WANG
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 1000
Mailing Address - Street 2:DEPT 479
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0479
Mailing Address - Country:US
Mailing Address - Phone:901-725-0421
Mailing Address - Fax:901-278-4675
Practice Address - Street 1:5100 SANDERLIN AVE STE 2100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4387
Practice Address - Country:US
Practice Address - Phone:901-820-0141
Practice Address - Fax:901-820-0144
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000308782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126261Medicaid
AR13848800Medicaid
130020264OtherRAILROAD MCARE
TN3838091Medicaid
MS00126261Medicaid
TN3838091Medicare ID - Type Unspecified