Provider Demographics
NPI:1407941883
Name:PRITCHETT, JAMES LARRY (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LARRY
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 PEARSON DR SW
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-1914
Mailing Address - Country:US
Mailing Address - Phone:229-995-2920
Mailing Address - Fax:229-995-5034
Practice Address - Street 1:162 E BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1841
Practice Address - Country:US
Practice Address - Phone:229-336-8991
Practice Address - Fax:229-336-0141
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T91782Medicare UPIN