Healthcare Provider Details

I. General information

NPI: 1073506754
Provider Name (Legal Business Name): JAMES ALLEN CRIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES H. QUILLEN VA MEDICAL CENTER CORNER OF LAMONT & VETERANS WAY
MT. HOME TN
37684
US

IV. Provider business mailing address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3685
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35809
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: