Provider Demographics
NPI:1710854997
Name:MOORE, JAMES ERVIN JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERVIN
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5213 ELLWORTH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 W NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1324
Practice Address - Country:US
Practice Address - Phone:336-355-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-15781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant