Active NPI
James Warner Clark, MD
- Family Medicine Physician
- Limestone, TN
National Provider Identifier
1982608428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 15468
- Practice address
- 105 Limestone Ruritan Rd
Limestone, TN 37681-2515 - Phone
- (423) 257-8089
- Fax
- (423) 257-5179
- NPI assigned
- Jun 13, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15468 | TN | Primary |
Addresses
Primary practice location
105 Limestone Ruritan Rd
Limestone, TN 37681-2515
Mailing address
PO Box 850
Rogersville, TN 37857-0850
Phone (423) 257-8089
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3010178 | Medicaid | TN | |
| 61386 | Other | TN | BCBST |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1982608428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 850",
"city": "ROGERSVILLE",
"state": "TN",
"postal_code": "378570850",
"telephone_number": "423-257-8089",
"fax_number": "423-257-5179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 LIMESTONE RURITAN RD",
"city": "LIMESTONE",
"state": "TN",
"postal_code": "376812515",
"telephone_number": "423-257-8089",
"fax_number": "423-257-5179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JAMES",
"middle_name": "WARNER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "15468",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3010178",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBST",
"identifier": "61386",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Limestone, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.