Provider Demographics
NPI:1326007113
Name:FIELDS, JULIAN HOWARD (MD)
Entity type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:HOWARD
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1959
Mailing Address - Country:US
Mailing Address - Phone:931-526-2155
Mailing Address - Fax:
Practice Address - Street 1:1080 NEAL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0942
Practice Address - Country:US
Practice Address - Phone:931-526-3316
Practice Address - Fax:931-526-3318
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023125207R00000X
TN42748207Q00000X
TNMD0000042748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515245Medicaid
AL631400173Medicaid
AL631411173Medicaid
AL515324154OtherBCBS
TN1515245Medicaid
ALG54483Medicare UPIN
AL631400173Medicaid
AL631411173Medicaid