Provider Demographics
NPI:1710968011
Name:TIMMONS, JAMES M JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:TIMMONS
Suffix:JR
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:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:216 E MARION ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1442
Practice Address - Country:US
Practice Address - Phone:803-475-3475
Practice Address - Fax:803-475-5360
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC198844OtherMEDCOST PIN
SCP00416733OtherRAILROAD MEDICARE PIN
SC080780Medicaid
SCB922416286Medicare PIN
SC080780Medicaid