Provider Demographics
NPI:1649242470
Name:EVERETT, JAMES EUGENE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EUGENE
Last Name:EVERETT
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 1:209 EXCALIBUR CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5150
Mailing Address - Country:US
Mailing Address - Phone:919-388-3774
Mailing Address - Fax:
Practice Address - Street 1:2500 CARPENTER UPCHURCH RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-7007
Practice Address - Country:US
Practice Address - Phone:919-380-3700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer