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NPI Code Detail

MEDICARE: DR. JAMES RANDALL WICKHAM M.D.

MEDICARE:  DR. JAMES RANDALL WICKHAM  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician0101046422VA

General Provider Information

NPI Number : 1740244615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES RANDALL WICKHAM M.D.
Provider Business Mailing Address
First Line : 2000 HEALTH PARK DR FL HP2
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-4692
Country : US
Telephone Number : 615-373-7600
Fax Number :
Provider Business Practice Location Address
First Line : 136 W ELIZABETH ST STE 102
Second Line :
City : HARRISONBURG
State : VA
Zip : 22802-3855
Country : US
Telephone Number : 540-564-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 08/23/2024

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Directions to “ DR. JAMES RANDALL WICKHAM M.D.” Practice Location

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