Healthcare Provider Details

I. General information

NPI: 1437105608
Provider Name (Legal Business Name): JAMES EDWARD ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MCARTHUR ST
MANCHESTER TN
37355-2522
US

IV. Provider business mailing address

801 HUNTINGTON CIR
NASHVILLE TN
37215-6112
US

V. Phone/Fax

Practice location:
  • Phone: 931-723-7950
  • Fax:
Mailing address:
  • Phone: 615-943-9294
  • Fax: 931-723-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberMD17117
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD17117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: