Healthcare Provider Details

I. General information

NPI: 1043205990
Provider Name (Legal Business Name): JAMES M. CARLILE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CAMBRIDGE CT
WETUMPKA AL
36093-1259
US

IV. Provider business mailing address

78 CAMBRIDGE CT
WETUMPKA AL
36093-1259
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-6915
  • Fax: 334-514-7269
Mailing address:
  • Phone: 334-567-6915
  • Fax: 334-514-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19637
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: