Provider Demographics
NPI:1336188457
Name:SPELLMAN, MICHAEL JAMES JR (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:SPELLMAN
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN375532085N0700X
NC2025-004422085R0202X
TNMD375532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4078470OtherBCBS
TN1641017OtherUNITED HEALTHCARE OF TN
TN4201804OtherBCBS TN
KY6406778800Medicaid
TN1509317OtherMEDICAID - MTI
KY64067788OtherKY MEDICAID
TNPENDINGOtherCIGNA
TN4062353OtherBCBS
TNP00960028OtherRR MEDICARE - MTI
TN1509317Medicaid
TN4062380OtherBCBS
TN4291381OtherBCBS - MTI
TNP00012845OtherRAILROAD MEDICARE
TN3884578Medicaid
TN4291381OtherBCBS - MTI
TN4201804OtherBCBS TN
KY6406778800Medicaid
TN3884577Medicare PIN
TN3884578Medicare PIN
TN3884579Medicare PIN