Provider Demographics
NPI:1043550148
Name:MCLELLAND, JAMES GODFREY JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GODFREY
Last Name:MCLELLAND
Suffix:JR
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 1:119 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5257
Mailing Address - Country:US
Mailing Address - Phone:704-873-7935
Mailing Address - Fax:704-873-7943
Practice Address - Street 1:119 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5257
Practice Address - Country:US
Practice Address - Phone:704-873-7935
Practice Address - Fax:704-873-7943
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist