Provider Demographics
NPI:1841267333
Name:GILLESPIE, JAMES T JR (MD, PC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:GILLESPIE
Suffix:JR
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:T
Other - Last Name:GILLESPIE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:1758 HILLWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-246-2104
Practice Address - Fax:865-246-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0162812084P0805X
TNMD0162812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3915381Medicaid
TN3015391Medicare PIN
TND71827Medicare UPIN