Provider Demographics
NPI:1588010540
Name:ANDERSON, JAMES (ATC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 PELHAM RD APT 466
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7801 N TIGERVILLE RD
Practice Address - Street 2:
Practice Address - City:TIGERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29688-9700
Practice Address - Country:US
Practice Address - Phone:864-867-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBOC335022204C00000X
390200000X
SC2000027634204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program