Provider Demographics
NPI:1790739027
Name:EUBANKS, JAMES WALLACE III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:EUBANKS
Suffix:III
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 1:49 NORTH DUNLAP STREET
Mailing Address - Street 2:SUITE 640
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3666
Mailing Address - Country:US
Mailing Address - Phone:901-287-6760
Mailing Address - Fax:
Practice Address - Street 1:51 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-287-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD284862086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126905Medicaid
AR152684001Medicaid
TN3875092Medicaid
TN3875092Medicaid
TN3875092Medicare ID - Type Unspecified