Provider Demographics
NPI:1932503075
Name:ELVIS, JAMES ALTON III (FNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALTON
Last Name:ELVIS
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:520 THURGOOD MARSHALL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4108
Practice Address - Country:US
Practice Address - Phone:843-355-5628
Practice Address - Fax:843-355-5616
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily