Healthcare Provider Details

I. General information

NPI: 1104730423
Provider Name (Legal Business Name): JAMES DEMEDICI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

116 MILLWOOD LN
NORTH AUGUSTA SC
29860-8739
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-9011
  • Fax:
Mailing address:
  • Phone: 423-433-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number206596
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: