Provider Demographics
NPI:1275804015
Name:BRACEY, JAMES MCLEOD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MCLEOD
Last Name:BRACEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD STE 310
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1923
Mailing Address - Country:US
Mailing Address - Phone:817-300-6744
Mailing Address - Fax:804-281-8019
Practice Address - Street 1:4606 BROMLEY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1202
Practice Address - Country:US
Practice Address - Phone:817-300-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275804015Medicaid
VA1275804015Medicare NSC