Provider Demographics
NPI:1104812817
Name:HEADRICK, JAMES ROBERT JR (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:HEADRICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-495-4349
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:605 GLENWOOD DRIVE, SUITE 105
Practice Address - Street 2:CHI MEMORIAL THORACIC ONCOLOGY ASSOCIATES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-5864
Practice Address - Fax:423-495-2065
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
TN24097208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073584Medicaid
TN3073584Medicaid
GAGRP3449Medicare PIN
TN3073584Medicaid