Provider Demographics
NPI:1871006775
Name:CLEARY, JAMES WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:CLEARY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9478
Mailing Address - Country:US
Mailing Address - Phone:919-734-8440
Mailing Address - Fax:919-734-9387
Practice Address - Street 1:103 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9478
Practice Address - Country:US
Practice Address - Phone:919-734-8440
Practice Address - Fax:919-734-8440
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871006775OtherNPI
NC0010-07711OtherNC MEDICAL LICENSE