Healthcare Provider Details

I. General information

NPI: 1013176023
Provider Name (Legal Business Name): KEVIN MCCOY JAMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CHEROKEE PROFESSIONAL PARK
MARYVILLE TN
37804-5153
US

IV. Provider business mailing address

252 CHEROKEE PROFESSIONAL PARK
MARYVILLE TN
37804-5153
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5200
  • Fax: 865-980-5201
Mailing address:
  • Phone: 865-980-5200
  • Fax: 865-980-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number239570
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: