Provider Demographics
NPI:1235122789
Name:BERRY, JAMES W (ATC, NREMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:BERRY
Suffix:
Gender:M
Credentials:ATC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4291 SUMMIT TRL
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6938
Mailing Address - Country:US
Mailing Address - Phone:843-340-6411
Mailing Address - Fax:
Practice Address - Street 1:2301 CHURCH STREET
Practice Address - Street 2:CONWAY HIGH SCHOOL
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-488-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18106146N00000X
SC0702255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic