Provider Demographics
NPI: | 1851341291 |
---|---|
Name: | POOLE, JAMES T (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | T |
Last Name: | POOLE |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | JIM |
Other - Middle Name: | |
Other - Last Name: | POOLE |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 2909 BEULAH CHURCH RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ARRINGTON |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37014-9125 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-395-0019 |
Mailing Address - Fax: | 615-395-0019 |
Practice Address - Street 1: | 200 STONECREST BLVD |
Practice Address - Street 2: | C/O JEAN SEALS MEDICAL STAFF COORDINATOR |
Practice Address - City: | SMYRNA |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37167-6810 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-768-2223 |
Practice Address - Fax: | 615-768-2723 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-10 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 31239 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3837177 | Medicaid | |
TN | 1508958 | Medicaid | |
TN | BP6166119 | Other | DEA |
G90145 | Medicare UPIN | ||
P00629594 | Medicare PIN | ||
TN | 3837177 | Medicaid |