Provider Demographics
NPI:1184620460
Name:ANDERSON, JAMES R (MD)
Entity type:Individual
Prefix:MISS
First Name:JAMES
Middle Name:R
Last Name:ANDERSON
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 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1347
Mailing Address - Country:US
Mailing Address - Phone:615-792-1911
Mailing Address - Fax:615-792-0619
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1347
Practice Address - Country:US
Practice Address - Phone:615-792-1911
Practice Address - Fax:615-792-0619
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD015576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3085455Medicaid
TNP00418596OtherRR MEDICARE
TN3085458Medicaid
TN3144340OtherBLUE CROSS BLUE SHIELD
TNP00233186OtherRAILROAD MEDICARE
TN3085455Medicaid
TNA97682Medicare UPIN
TN30854551Medicare PIN