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NPI Code Detail

MEDICARE: MR. JAMES ALLEN SUDBERRY DPM

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
1213E00000XPodiatristDPM0000000644TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14111238OTHERTNBLUE 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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Directions to “ MR. JAMES ALLEN SUDBERRY DPM” Practice Location

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