Provider Demographics
NPI:1780076307
Name:DESROSIERS, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DESROSIERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BREEZY PT
Mailing Address - Street 2:RR8
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7208
Mailing Address - Country:US
Mailing Address - Phone:803-617-9894
Mailing Address - Fax:
Practice Address - Street 1:600 SUMMERLAND AVE
Practice Address - Street 2:
Practice Address - City:BATESBURG-LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29006-1429
Practice Address - Country:US
Practice Address - Phone:803-604-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator