Provider Demographics
NPI:1932254489
Name:BUTTS, JIMMY CHARLES (CO)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:CHARLES
Last Name:BUTTS
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1840 OWEN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1633
Mailing Address - Country:US
Mailing Address - Phone:910-484-2645
Mailing Address - Fax:910-484-0866
Practice Address - Street 1:1840 OWEN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1633
Practice Address - Country:US
Practice Address - Phone:910-484-2645
Practice Address - Fax:910-484-0866
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795000Medicaid