Provider Demographics
NPI:1073940482
Name:ATHA, JAMES CARL JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CARL
Last Name:ATHA
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3030 CANYON TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-7621
Mailing Address - Country:US
Mailing Address - Phone:806-282-8999
Mailing Address - Fax:
Practice Address - Street 1:3030 CANYON TRAIL RD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-7621
Practice Address - Country:US
Practice Address - Phone:806-282-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124431208VP0014X, 367500000X
TX754112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine