Provider Demographics
NPI:1588228100
Name:MCCANN, JAMES K
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:MCCANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121B CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-8787
Mailing Address - Country:US
Mailing Address - Phone:601-410-5836
Mailing Address - Fax:888-449-9560
Practice Address - Street 1:1121B CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-8787
Practice Address - Country:US
Practice Address - Phone:601-410-5836
Practice Address - Fax:888-449-9560
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03071991OtherTRANSPORATION