Provider Demographics
NPI:1760548432
Name:RAY, JAMES J (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:RAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8602
Mailing Address - Fax:
Practice Address - Street 1:10 PATEWOOD DR STE 130
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6317
Practice Address - Country:US
Practice Address - Phone:864-455-8988
Practice Address - Fax:864-455-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME16562084P0800X
SC837742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10593Medicare UPIN
MEMM8165Medicare PIN
MEMM816502Medicare PIN