Provider Demographics
NPI:1649273467
Name:KILLIAN, JAMES WENDALL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WENDALL
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0540
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:402 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1238
Practice Address - Country:US
Practice Address - Phone:606-549-2656
Practice Address - Fax:606-549-2855
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34305207Q00000X
KY35670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35670OtherSTATE LICENSE
TNQ022263Medicaid
TN034305OtherSTATE LICENSE
KY64017809Medicaid
KY64017809Medicaid
TNBK6879514OtherDEA