Healthcare Provider Details

I. General information

NPI: 1467405274
Provider Name (Legal Business Name): JAMES STRATTON SNOW JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 WELLNESS WAY
ST. SIMONS ISLAND GA
31522-2287
US

IV. Provider business mailing address

PO BOX 1213
BRUNSWICK GA
31521-1213
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-5900
  • Fax: 912-466-5913
Mailing address:
  • Phone: 912-466-5900
  • Fax: 912-466-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number013569
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: