Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS2821 | TN |
Y | 213EG0000X | General Practice | DS2821 | TN |
NPI | 1003807678 |
---|---|
Provider Name | Dr. James R. Elrod |
First Address | Greenback, TN 37742-0126 |
Second Address | Greenback, TN 37742-4245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 05/07/2011 |