Healthcare Provider Details

I. General information

NPI: 1053350637
Provider Name (Legal Business Name): JAMES HENRY BURLESON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BROOKSIDE DR INDIAN PATH HOSPITAL
KINGSPORT TN
37660-4627
US

IV. Provider business mailing address

2545 ESSEX DR
KINGSPORT TN
37660-4750
US

V. Phone/Fax

Practice location:
  • Phone: 423-857-7870
  • Fax: 423-857-7872
Mailing address:
  • Phone: 423-288-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number019941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: