Healthcare Provider Details

I. General information

NPI: 1720348246
Provider Name (Legal Business Name): JAMES A MAYS M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 S BROADWAY
LOS ANGELES CA
90003-3628
US

IV. Provider business mailing address

PO BOX 73538
LOS ANGELES CA
90003-0538
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-7697
  • Fax: 323-778-2431
Mailing address:
  • Phone: 323-778-7697
  • Fax: 323-778-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC31115
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC31115
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC31115
License Number StateCA

VIII. Authorized Official

Name: JAMES A MAYS
Title or Position: PRESIDENT
Credential: M D
Phone: 323-778-7697