Provider Demographics
NPI:1356391916
Name:ACKER, JAMES D (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:ACKER
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:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38159-0001
Mailing Address - Country:US
Mailing Address - Phone:901-383-8860
Mailing Address - Fax:901-383-8985
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-383-8860
Practice Address - Fax:901-383-8985
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN126262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3034801Medicaid
TN0070884OtherTN BCBS
MS0116264Medicaid
AR110066001Medicaid
MO202059408Medicaid
AR80101OtherAR BCBS
MS0116264Medicaid
MS300000488Medicare ID - Type UnspecifiedMS M'CARE
AR110066001Medicaid
MO202059408Medicaid