Provider Demographics
NPI:1952487936
Name:COLE, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3660 HOWELL FERRY RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3178
Mailing Address - Country:US
Mailing Address - Phone:765-883-2273
Mailing Address - Fax:765-883-5168
Practice Address - Street 1:101 S. LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:RUSSIAVILLE
Practice Address - State:IN
Practice Address - Zip Code:46979
Practice Address - Country:US
Practice Address - Phone:765-883-2273
Practice Address - Fax:765-883-5168
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151560I7Medicare PIN
IN191630AAMedicare PIN
INR61428Medicare UPIN
970014766Medicare PIN