Provider Demographics
NPI:1831400142
Name:MABON, JAMES ALVIN JR
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALVIN
Last Name:MABON
Suffix:JR
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 1:3914 POINT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-4945
Mailing Address - Country:US
Mailing Address - Phone:901-240-4072
Mailing Address - Fax:
Practice Address - Street 1:3914 POINT CHURCH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-4945
Practice Address - Country:US
Practice Address - Phone:901-240-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid