Provider Demographics
NPI:1699847459
Name:GLEAVES, JAMES EVERETT JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EVERETT
Last Name:GLEAVES
Suffix:JR
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 1:200 BLOUNT AVENUE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-577-2588
Mailing Address - Fax:865-573-4331
Practice Address - Street 1:200 BLOUNT AVENUE
Practice Address - Street 2:SUITE 503
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-577-2588
Practice Address - Fax:865-573-4331
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002033OtherBCBST
3165360Medicare ID - Type Unspecified
2002033OtherBCBST