Provider Demographics
NPI:1851341291
Name:POOLE, JAMES T (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:POOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2909 BEULAH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:37014-9125
Mailing Address - Country:US
Mailing Address - Phone:615-395-0019
Mailing Address - Fax:615-395-0019
Practice Address - Street 1:200 STONECREST BLVD
Practice Address - Street 2:C/O JEAN SEALS MEDICAL STAFF COORDINATOR
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6810
Practice Address - Country:US
Practice Address - Phone:615-768-2223
Practice Address - Fax:615-768-2723
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3837177Medicaid
TN1508958Medicaid
TNBP6166119OtherDEA
G90145Medicare UPIN
P00629594Medicare PIN
TN3837177Medicaid