Provider Demographics
NPI:1801041157
Name:STILL, JAMES GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GORDON
Last Name:STILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 OAK WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6346
Mailing Address - Country:US
Mailing Address - Phone:919-848-8227
Mailing Address - Fax:
Practice Address - Street 1:4816 OAK WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6346
Practice Address - Country:US
Practice Address - Phone:919-848-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25191208000000X
VA0101032803208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics