Provider Demographics
NPI:1821014002
Name:VILLIER, JAMES A (MD FACP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:VILLIER
Suffix:
Gender:M
Credentials:MD FACP
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-6565
Mailing Address - Fax:704-316-6560
Practice Address - Street 1:6324 FAIRVIEW RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3271
Practice Address - Country:US
Practice Address - Phone:704-316-6565
Practice Address - Fax:704-316-6560
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110203312OtherRAILROAD MCR PROVIDER #
SCN21321Medicaid
NC7985085Medicaid
NCC86925Medicare UPIN
SCN21321Medicaid
NC211194MMedicare PIN
NC7985085Medicaid