Provider Demographics
NPI:1639149214
Name:SOUTH, JAMES WILLIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIS
Last Name:SOUTH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:175 S UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3126
Mailing Address - Country:US
Mailing Address - Phone:719-365-1950
Mailing Address - Fax:719-365-1951
Practice Address - Street 1:175 S UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-365-1951
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO797363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03086712Medicaid
CO269864YLB8Medicare PIN
CODAD000Medicare UPIN