Provider Demographics
NPI:1306872494
Name:FITCH, JAMES MILTON (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MILTON
Last Name:FITCH
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 1:2546 WARD BLVD
Mailing Address - Street 2:101 E 2ND ST
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-399-0707
Mailing Address - Fax:252-291-7079
Practice Address - Street 1:2546 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-399-0707
Practice Address - Fax:252-291-7079
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCIP103230363A00000X
NC103230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12330Medicare UPIN