Provider Demographics
NPI:1962489732
Name:DOUGLAS, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:DOUGLAS
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 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3278
Mailing Address - Fax:
Practice Address - Street 1:15 RIVERBEND DR SW
Practice Address - Street 2:STE 100 & 200
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6065
Practice Address - Country:US
Practice Address - Phone:706-291-0884
Practice Address - Fax:706-235-0405
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033569207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00502774FMedicaid
GA08BDHXMOtherMEDICARE
GA00502774EMedicaid
GACL0326OtherRAILROAD MEDICARE
GACL0326OtherRAILROAD MEDICARE