Provider Demographics
NPI:1770911133
Name:BOARD OF PUBLIC WORKS
Entity type:Organization
Organization Name:BOARD OF PUBLIC WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:864-649-2192
Mailing Address - Street 1:210 E FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2426
Mailing Address - Country:US
Mailing Address - Phone:864-649-2192
Mailing Address - Fax:864-642-3571
Practice Address - Street 1:210 E FREDERICK ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2426
Practice Address - Country:US
Practice Address - Phone:864-649-2192
Practice Address - Fax:864-642-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17724261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care