Healthcare Provider Details

I. General information

NPI: 1790788180
Provider Name (Legal Business Name): JAMES A DALTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/12/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 OLD ABBOTT MOUNTAIN RD
PRESTONSBURG KY
41653
US

IV. Provider business mailing address

1573 MALLORY LN STE 100
BRENTWOOD TN
37027-2895
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-0892
  • Fax: 606-886-9746
Mailing address:
  • Phone: 615-221-3855
  • Fax: 615-221-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA682
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: