Provider Demographics
NPI:1467779322
Name:RICHARD, JAMES JOHN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:405 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-3183
Mailing Address - Fax:910-745-8478
Practice Address - Street 1:405 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-3183
Practice Address - Fax:910-745-8478
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant