Provider Demographics
NPI:1043205990
Name:CARLILE, JAMES M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:CARLILE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1259
Mailing Address - Country:US
Mailing Address - Phone:334-567-6915
Mailing Address - Fax:334-514-7269
Practice Address - Street 1:78 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1259
Practice Address - Country:US
Practice Address - Phone:334-567-6915
Practice Address - Fax:334-514-7269
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515392OtherBLUE CROSS
AL009921105Medicaid
G61315Medicare UPIN
AL051515392Medicare ID - Type Unspecified