Healthcare Provider Details

I. General information

NPI: 1336142520
Provider Name (Legal Business Name): JAMES W BOALS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 POPLAR PIKE SUITE 101
GERMANTOWN TN
38138-5947
US

IV. Provider business mailing address

7695 POPLAR PIKE SUITE 101
MEMPHIS TN
38138-5947
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-2696
  • Fax:
Mailing address:
  • Phone: 901-685-2696
  • Fax: 901-682-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number30695
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number30695
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number15946
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: