Healthcare Provider Details

I. General information

NPI: 1821121252
Provider Name (Legal Business Name): JAMES TIMOTHY THREADGILL D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MARKET ST
CHATTANOOGA TN
37405-3905
US

IV. Provider business mailing address

1210 DUGDALE ST
CHATTANOOGA TN
37405-3620
US

V. Phone/Fax

Practice location:
  • Phone: 423-752-8104
  • Fax:
Mailing address:
  • Phone: 423-752-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5967
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number5967
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number5967
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5967
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number5967
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: