Provider Demographics
NPI:1376635052
Name:COUCH, JAMES C III (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:COUCH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-540-4255
Mailing Address - Fax:931-379-5867
Practice Address - Street 1:200 S CROSS BRIDGES RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1714
Practice Address - Country:US
Practice Address - Phone:931-379-5821
Practice Address - Fax:931-379-5867
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4022000OtherBCBSTN
TN3710089Medicaid
TN3800692Medicaid
TN3800692Medicaid
TNCE0561Medicare PIN
3710089Medicare PIN
TN3710089Medicaid
TNG29461Medicare UPIN