Provider Demographics
NPI:1508131582
Name:CONWELL, JAMES ROBERT (ATP, SMS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:CONWELL
Suffix:
Gender:M
Credentials:ATP, SMS
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:ROBERT
Other - Last Name:CONWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATP, CRTS
Mailing Address - Street 1:11110 METRIC BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4097
Mailing Address - Country:US
Mailing Address - Phone:512-738-8818
Mailing Address - Fax:
Practice Address - Street 1:11110 METRIC BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4097
Practice Address - Country:US
Practice Address - Phone:737-343-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247200000X174400000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No174400000XOther Service ProvidersSpecialist