Provider Demographics
NPI:1205723400
Name:GOMEZ, JAMES ANDREW
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 FENNEC WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1456
Mailing Address - Country:US
Mailing Address - Phone:931-260-0278
Mailing Address - Fax:
Practice Address - Street 1:120 W DUNBAR CAVE RD # AB
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6774
Practice Address - Country:US
Practice Address - Phone:931-538-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician