Provider Demographics
NPI:1194866095
Name:ALTIZER, JAMES WITTEN (MD, FACPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WITTEN
Last Name:ALTIZER
Suffix:
Gender:M
Credentials:MD, FACPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 PARK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8479
Mailing Address - Country:US
Mailing Address - Phone:704-341-1122
Mailing Address - Fax:704-341-2085
Practice Address - Street 1:10502 PARK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8479
Practice Address - Country:US
Practice Address - Phone:704-341-1122
Practice Address - Fax:704-341-2085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist