Provider Demographics
NPI:1700802618
Name:CLEVELAND, JAMES E IV (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:CLEVELAND
Suffix:IV
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 3330
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3330
Mailing Address - Country:US
Mailing Address - Phone:931-647-5034
Mailing Address - Fax:931-552-6663
Practice Address - Street 1:2021 N CAROTHERS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5822
Practice Address - Country:US
Practice Address - Phone:615-435-5000
Practice Address - Fax:615-595-4481
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD42302207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000229Medicaid
4155112OtherBCBS PROVIDER NUMBER
P00402989OtherRAILROAD MEDICARE
4155112OtherBCBS PROVIDER NUMBER