Provider Demographics
NPI:1962564476
Name:THACKER, JAMES DEWEY JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEWEY
Last Name:THACKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 CHATEAU DR SW STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7413
Mailing Address - Country:US
Mailing Address - Phone:256-858-1605
Mailing Address - Fax:256-885-1905
Practice Address - Street 1:185 CHATEAU DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6012
Practice Address - Country:US
Practice Address - Phone:256-885-1605
Practice Address - Fax:256-885-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40660207LP2900X
ALAL 13577207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-22515OtherBLUE CROSS
AL102I091140Medicare PIN
COC71589Medicare UPIN
AL511-22515OtherBLUE CROSS
COC803293Medicare PIN