Provider Demographics
NPI:1821012998
Name:WALLWORK, JAMES CALEB (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CALEB
Last Name:WALLWORK
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 1:8237 ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7311
Mailing Address - Country:US
Mailing Address - Phone:615-370-3500
Mailing Address - Fax:
Practice Address - Street 1:1223 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3531
Practice Address - Country:US
Practice Address - Phone:931-840-4200
Practice Address - Fax:931-840-5757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN05380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBO2261Medicare UPIN
TN3088423Medicare ID - Type Unspecified