Provider Demographics
NPI:1467441626
Name:PREVOST, JAMES MICHAEL (EDD, SCAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:PREVOST
Suffix:
Gender:M
Credentials:EDD, SCAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 T R HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3487
Mailing Address - Country:US
Mailing Address - Phone:704-466-8820
Mailing Address - Fax:
Practice Address - Street 1:224 T R HARRIS DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3487
Practice Address - Country:US
Practice Address - Phone:704-466-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24622083S0010X, 204C00000X, 208100000X, 225400000X, 246ZX2200X, 2255A2300X, 174400000X, 2255A2300X, 225400000X
NC0391174400000X, 204C00000X, 225400000X, 2255A2300X, 246ZX2200X
NC856475174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator