Provider Demographics
NPI:1003908138
Name:DENMARK, JAMES AUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AUSTIN
Last Name:DENMARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2260 WRIGHTSBORO RD
Mailing Address - Street 2:SUITE 154
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4764
Mailing Address - Country:US
Mailing Address - Phone:706-364-0263
Mailing Address - Fax:
Practice Address - Street 1:2260 WRIGHTSBORO RD
Practice Address - Street 2:SUITE 154
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4764
Practice Address - Country:US
Practice Address - Phone:706-364-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000953213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00972903AMedicaid
GAU92338Medicare UPIN
GA00972903AMedicaid