Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 239570 | TN |
NPI | 1013176023 |
---|---|
Provider Name | Kevin Mccoy James |
First Address | Maryville, TN 37804-5153 |
Second Address | Maryville, TN 37804-5153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 17/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1529413 | (05) | TN |