Provider Demographics
NPI:1659365773
Name:REYNOLDS, JAMES MCKENDREE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MCKENDREE
Last Name:REYNOLDS
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 1:7914 GLEASON DR
Mailing Address - Street 2:CONDO 1121
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5402
Mailing Address - Country:US
Mailing Address - Phone:865-531-8621
Mailing Address - Fax:
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:KNOX COUNTY HEALTH DEPT
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99344Medicare UPIN