MEDICARE: DR. WILLIAM JAMES STACKHOUSE M.D.

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	207R00000X	Internal Medicine Physician	24298	NC

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	:	1801899133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JAMES STACKHOUSE M.D.

Provider Business Mailing Address
First Line	:	1560 CLINGMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2162
Country	:	US
Telephone Number	:	919-734-9455
Fax Number	:	919-734-4769

Provider Business Practice Location Address
First Line	:	1560 CLINGMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2162
Country	:	US
Telephone Number	:	919-731-1000
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/01/2026

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