Provider Demographics
NPI:1508831215
Name:MECKES, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:MECKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 AVALON AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2869
Mailing Address - Country:US
Mailing Address - Phone:256-386-1125
Mailing Address - Fax:256-386-1126
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-386-1125
Practice Address - Fax:256-386-1126
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL15674Medicaid
AL529001490OtherMEDICAID GROUP NUMBER
AL1790879559OtherGROUP NPI
AL15674OtherBCBS AL PMD
ALC70876Medicare UPIN
AL15674Medicare ID - Type Unspecified