Provider Demographics
NPI:1265435564
Name:BAZEMORE, JAMES K (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:BAZEMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5502
Mailing Address - Country:US
Mailing Address - Phone:912-354-4813
Mailing Address - Fax:912-354-7569
Practice Address - Street 1:1115 LEXINGTON AVE
Practice Address - Street 2:BLDG 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5502
Practice Address - Country:US
Practice Address - Phone:912-354-4813
Practice Address - Fax:912-354-7569
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037953174400000X, 207RN0300X
SC15425174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00597583CMedicaid
SC154255Medicaid
GA00597583AMedicaid
GA00597583AMedicaid
GA00597583CMedicaid
GA39BDBSB05Medicare ID - Type UnspecifiedMEDICARE/SPRINGFIELD
GA39BDBSB07Medicare ID - Type UnspecifiedMEDICARE/DAVITA
SC154255Medicaid
SCE207326720Medicare ID - Type UnspecifiedSC MEDICARE