Provider Demographics
NPI:1467784926
Name:LITTLE, JAMES BLAKE (IDMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BLAKE
Last Name:LITTLE
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8759
Mailing Address - Country:US
Mailing Address - Phone:706-400-9596
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOW RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8759
Practice Address - Country:US
Practice Address - Phone:706-400-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians