Provider Demographics
NPI:1912984949
Name:JAMES, DAVID L (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:JAMES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:L
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3670 S NEW HOPE RD
Mailing Address - Street 2:SUITE A1 AND A2
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8395
Mailing Address - Country:US
Mailing Address - Phone:704-824-4560
Mailing Address - Fax:704-478-8194
Practice Address - Street 1:3670 S NEW HOPE RD
Practice Address - Street 2:SUITE A1 AND A2
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8395
Practice Address - Country:US
Practice Address - Phone:704-824-4560
Practice Address - Fax:704-478-8194
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12911Medicare UPIN
NC2752888BMedicare PIN