Provider Demographics
NPI:1659990646
Name:SURRATT, JAMES LIONEL JR (PD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LIONEL
Last Name:SURRATT
Suffix:JR
Gender:M
Credentials:PD
Other - Prefix:
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Mailing Address - Street 1:1208 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-1217
Mailing Address - Country:US
Mailing Address - Phone:276-228-2178
Mailing Address - Fax:276-228-3095
Practice Address - Street 1:289 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2331
Practice Address - Country:US
Practice Address - Phone:276-228-2178
Practice Address - Fax:276-228-3095
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202205254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist