Provider Demographics
NPI:1588628549
Name:JOHN, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-984-4365
Mailing Address - Fax:704-983-7856
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4365
Practice Address - Fax:704-983-7856
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588628549Medicaid
NC46038OtherBCBS NC
NC5051204OtherAETNA
NC14989OtherPARTNERS MEDICARE
NC65464OtherMEDCOST
NC8946038Medicaid
SCN81096Medicaid
NC65464OtherMEDCOST
NC2226877AMedicare PIN
NC1588628549Medicaid
NC5051204OtherAETNA
NC8946038Medicaid
NCNCL405BMedicare PIN