Provider Demographics
NPI:1720269616
Name:VANWINKLE, JAMES DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DARRELL
Last Name:VANWINKLE
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 1:2166 JACKSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-5603
Mailing Address - Country:US
Mailing Address - Phone:423-202-1406
Mailing Address - Fax:
Practice Address - Street 1:1030 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2453
Practice Address - Country:US
Practice Address - Phone:931-954-5125
Practice Address - Fax:931-954-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43715208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program