Active NPI
James Douglas Wilson, LCSW
- Social Worker
- Johnson City, TN
National Provider Identifier
1255344396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCSW709
- Practice address
- 607 Baxter St
Fairview Associates
Johnson City, TN 37601 - Phone
- (423) 232-2720
- Fax
- (423) 928-0381
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCSW709 | TN | Primary |
Addresses
Primary practice location
607 Baxter St
Fairview Associates
Johnson City, TN 37601
Mailing address
PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0128301 | Other | MAGELLAN NAVIGATOR | |
| 189387 FVJC | Other | ANTHEM PROF TRIGON | |
| 33476 | Other | UBH EMPLOYER | |
| 334969 | Other | VALUEOPTIONS GROUP | |
| 0128301 | Other | MAGELLAN SUMMIT | |
| 0128301 | Other | MAGELLAN EAP | |
| 1046524 | Other | FIRST HEALTH | |
| 0128301 | Other | MAGELLAN PINNACLE | |
| 104224 | Other | VALUEOPTIONS | |
| 55538 | Other | CIGNA MCC | |
| 189387 FVJC | Other | ANTHEM PREF TRIGON | |
| 33476 | Other | UBH HEALTHPLAN | |
| 33476 | Other | UBH SENIOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW709 | TN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1255344396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9054",
"city": "GRAY",
"state": "TN",
"postal_code": "376159054",
"telephone_number": "423-467-3600",
"fax_number": "423-467-3696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 BAXTER ST",
"address_2": "FAIRVIEW ASSOCIATES",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "37601",
"telephone_number": "423-232-2720",
"fax_number": "423-928-0381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JAMES",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "LCSW709",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN NAVIGATOR",
"identifier": "0128301",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROF TRIGON",
"identifier": "189387 FVJC",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH EMPLOYER",
"identifier": "33476",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS GROUP",
"identifier": "334969",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN SUMMIT",
"identifier": "0128301",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN EAP",
"identifier": "0128301",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1046524",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN PINNACLE",
"identifier": "0128301",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "104224",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA MCC",
"identifier": "55538",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PREF TRIGON",
"identifier": "189387 FVJC",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH HEALTHPLAN",
"identifier": "33476",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH SENIOR",
"identifier": "33476",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.