Provider Demographics
NPI:1063047140
Name:JAMES, BRIAN KEITH
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:JAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5893 GARDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-8463
Mailing Address - Country:US
Mailing Address - Phone:901-299-4527
Mailing Address - Fax:
Practice Address - Street 1:5893 GARDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-8463
Practice Address - Country:US
Practice Address - Phone:901-299-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus