Basic Information
| Provider Information | |||||||||
| NPI: | 1326007113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 866 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385011959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315262155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1080 NEAL ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385010942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315263316 | ||||||||
| FaxNumber: | 9315263318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 07/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00023125 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 42748 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD0000042748 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1515245 | 05 | TN | MEDICAID | 631400173 | 05 | AL | MEDICAID | 631411173 | 05 | AL | MEDICAID | 515324154 | 01 | AL | BCBS | OTHER |