Provider Demographics
NPI:1770539819
Name:PALMER, JAMES T (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:PALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:M
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:189 PROFESSIONAL CT SE SUITE 106
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-0128
Mailing Address - Country:US
Mailing Address - Phone:706-602-9995
Mailing Address - Fax:
Practice Address - Street 1:1035 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-6008
Practice Address - Country:US
Practice Address - Phone:706-602-9995
Practice Address - Fax:706-624-0271
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5106207L00000X
GA056209207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393526OtherBLUE CROSS BLUE SHIELD
GACM 5659OtherRAILROAD GRP NUMBER
GA201213081AMedicaid
GAP00250447OtherRAILROAD MEDICARE PART B
GAGRP 332OtherMEDICARE GRP NUMBER
GAH22363Medicare UPIN
GA393526OtherBLUE CROSS BLUE SHIELD