Provider Demographics
NPI:1972009835
Name:PRESGRAVES, JAMES SHELBY
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SHELBY
Last Name:PRESGRAVES
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-264-6000
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:360 SIMPSON HIGHWAY 149 STE 150
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3846
Practice Address - Country:US
Practice Address - Phone:601-264-6000
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine