Provider Demographics
NPI:1689671802
Name:ANDERSON, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:ANDERSON
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 1:314 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2304
Mailing Address - Country:US
Mailing Address - Phone:615-851-5757
Mailing Address - Fax:615-851-4607
Practice Address - Street 1:314 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2304
Practice Address - Country:US
Practice Address - Phone:615-851-5757
Practice Address - Fax:615-851-4607
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3055113Medicaid
TN3055113Medicare ID - Type Unspecified
A72459Medicare UPIN