Provider Demographics
NPI:1013176023
Name:JAMES, KEVIN MCCOY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MCCOY
Last Name:JAMES
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 1:252 CHEROKEE PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5153
Mailing Address - Country:US
Mailing Address - Phone:865-980-5200
Mailing Address - Fax:865-980-5201
Practice Address - Street 1:252 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5153
Practice Address - Country:US
Practice Address - Phone:865-980-5200
Practice Address - Fax:865-980-5201
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN239570207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529413Medicaid
TN103I114811Medicare PIN