Provider Demographics
NPI:1316949191
Name:BUTLER, JAMES BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BLAIR
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1224 TROTWOOD AVE
Mailing Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, PLLC
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4802
Mailing Address - Country:US
Mailing Address - Phone:931-647-5034
Mailing Address - Fax:931-552-6663
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, PLLC
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-647-5034
Practice Address - Fax:931-552-6663
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD212362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4003539OtherBLUE CROSS PROVIDER NUMBE
TN3861110Medicaid
TN3861110Medicare PIN
TN4003539OtherBLUE CROSS PROVIDER NUMBE