Provider Demographics
NPI:1972790640
Name:HARLEY, JAMES KRISTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KRISTIN
Last Name:HARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:HARLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2555 COURT DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-671-7652
Mailing Address - Fax:704-671-7656
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 450
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-671-7652
Practice Address - Fax:704-671-7656
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1652208600000X, 2086S0102X
NC2013-02504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719270040Medicare PIN
IA1972790640Medicaid