Basic Information
Provider Information | |||||||||
NPI: | 1649362914 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SLEMMER | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5301 VIRGINIA WAY | ||||||||
Address2: | STE 300 | ||||||||
City: | BRENTWOOD | ||||||||
State: | TN | ||||||||
PostalCode: | 370277541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152214474 | ||||||||
FaxNumber: | 6152343774 | ||||||||
Practice Location | |||||||||
Address1: | 5301 VIRGINIA WAY | ||||||||
Address2: | STE 300 | ||||||||
City: | BRENTWOOD | ||||||||
State: | TN | ||||||||
PostalCode: | 370277541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152214474 | ||||||||
FaxNumber: | 6152343774 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/28/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 40515 | TN | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
ID | Type | State | Issuer | Description | 000000036439 | 01 | TN | TLC TENNCARE | OTHER | 10057940 | 01 | GA | AMERIGROUP MEDICAID GACMO | OTHER | 64115140 | 05 | KY |   | MEDICAID | 182928 | 01 | TN | UNISON TENNCARE | OTHER | 335779 | 01 | GA | WELLCARE MEDICAID GA CMO | OTHER | 4117600 | 01 | TN | BLUE CROSS | OTHER | 3336520 | 05 | TN |   | MEDICAID | 5903374 | 05 | NC |   | MEDICAID |