Provider Demographics
NPI:1245524297
Name:JAMES, LIZZIE L (NP)
Entity type:Individual
Prefix:MS
First Name:LIZZIE
Middle Name:L
Last Name:JAMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HOLLY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6403
Mailing Address - Country:US
Mailing Address - Phone:301-807-0198
Mailing Address - Fax:
Practice Address - Street 1:3300 BRIGGS CHANEY RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4811
Practice Address - Country:US
Practice Address - Phone:301-847-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073903261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center