Basic Information
| Provider Information | |||||||||
| NPI: | 1730129735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINDER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BERNARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2344 DAWNS PASS | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379199103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657761295 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 886 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633600 | ||||||||
| FaxNumber: | 4232633601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
| 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 | 207P00000X | 13136 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 26303 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00451596 | 01 | MS | RAILROAD MCARE | OTHER | 00125207 | 05 | MS | MEDICAID | 1367664 | 05 | LA | MEDICAID | 1508722 | 05 | TN | MEDICAID | P00833978 | 01 | MS | RAILROAD MCARE THRU HCCN | OTHER | 4185191 | 01 | TN | BCBS OF TN | OTHER | P00667675 | 01 | TN | RAILROAD MCARE THRU AMS | OTHER |