Healthcare Provider Details

I. General information

NPI: 1679555858
Provider Name (Legal Business Name): JAMES R. KIMBLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 KAY ST
KNOXVILLE TN
37920-1625
US

IV. Provider business mailing address

2020 KAY ST
KNOXVILLE TN
37920-1625
US

V. Phone/Fax

Practice location:
  • Phone: 865-579-3920
  • Fax: 865-579-3963
Mailing address:
  • Phone: 865-579-3920
  • Fax: 865-579-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD14798
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: