Provider Demographics
NPI:1790981355
Name:CLAIBORNE, JAMES W JR (CPO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:CLAIBORNE
Suffix:JR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 HAWTHORNE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2915
Mailing Address - Country:US
Mailing Address - Phone:704-333-4700
Mailing Address - Fax:
Practice Address - Street 1:1041 HAWTHORNE LN
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2915
Practice Address - Country:US
Practice Address - Phone:704-333-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC142873335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795248Medicaid