Provider Demographics
NPI:1821126871
Name:OTEY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OTEY
Suffix:
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 K
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-9710
Mailing Address - Country:US
Mailing Address - Phone:919-731-6595
Mailing Address - Fax:919-580-9224
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6595
Practice Address - Fax:919-580-9224
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54856Medicare UPIN
2770057AMedicare PIN
2770057Medicare PIN
97WCGTFMedicare PIN