Healthcare Provider Details

I. General information

NPI: 1144317801
Provider Name (Legal Business Name): JAMES M VANCE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LOWE AVE SUITE A
COOKEVILLE TN
38501
US

IV. Provider business mailing address

350 SOUTH LOWE AVE SUITE A
COOKEVILLE TN
38501
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-1050
  • Fax: 931-526-8163
Mailing address:
  • Phone: 931-526-1050
  • Fax: 931-526-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA207
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: