Provider Demographics
NPI:1205338654
Name:MEUCCI, JAMES ROBERT
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MEUCCI
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 1:316 JEFFERSON CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2635
Mailing Address - Country:US
Mailing Address - Phone:910-638-7199
Mailing Address - Fax:
Practice Address - Street 1:316 JEFFERSON CIR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2635
Practice Address - Country:US
Practice Address - Phone:910-638-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist