MEDICARE: MR. JAMES ALLEN SUDBERRY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	DPM0000000644	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4111238	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1578665188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ALLEN SUDBERRY DPM

Provider Business Mailing Address
First Line	:	PO BOX 306025
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6025
Country	:	US
Telephone Number	:	615-425-2708
Fax Number	:	615-370-0778

Provider Business Practice Location Address
First Line	:	300 STONECREST BLVD STE 255
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6837
Country	:	US
Telephone Number	:	615-220-2982
Fax Number	:	615-220-2984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	04/04/2008

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