Provider Demographics
NPI:1659360733
Name:CARRUTH, JAMES C (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:CARRUTH
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 1:96 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2070
Mailing Address - Country:US
Mailing Address - Phone:731-664-8771
Mailing Address - Fax:731-664-7050
Practice Address - Street 1:300 HOSPITAL CIR STE 201
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4597
Practice Address - Country:US
Practice Address - Phone:731-641-2765
Practice Address - Fax:731-641-2764
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22079207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0007692051OtherAETNA
TN621582944OtherTAX ID-COMMERCIAL
TN3041772OtherBCBS TN
TN3807536Medicaid
TN3807536Medicaid
TN3041772OtherBCBS TN