Provider Demographics
NPI:1912060518
Name:ARTIS, ISAAC AMOS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:AMOS
Last Name:ARTIS
Suffix:JR
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:PO BOX 7304
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-7304
Mailing Address - Country:US
Mailing Address - Phone:252-756-6986
Mailing Address - Fax:252-756-1197
Practice Address - Street 1:80 HOWELL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5316
Practice Address - Country:US
Practice Address - Phone:252-756-6986
Practice Address - Fax:252-756-1197
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912037Medicaid
NC12037OtherBLUE CROSS BLUE SHIELD
NC12037OtherBLUE CROSS BLUE SHIELD
NC202182CMedicare PIN