MEDICARE: MR. JAMES MOATES SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	008627627	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518623347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MOATES SR.

Provider Business Mailing Address
First Line	:	PO BOX 1505
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-1505
Country	:	US
Telephone Number	:	864-535-5540
Fax Number	:	866-209-0069

Provider Business Practice Location Address
First Line	:	317 NEW NEELY FERRY RD STE 1
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2659
Country	:	US
Telephone Number	:	864-535-5540
Fax Number	:	866-209-0069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	11/16/2021

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Directions to “ MR. JAMES MOATES SR. ” Practice Location

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