Healthcare Provider Details

I. General information

NPI: 1790759975
Provider Name (Legal Business Name): JAMES ALLEN CAUDILL II RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 WELTON CIR
JACKSONVILLE NC
28546-7345
US

IV. Provider business mailing address

PSC 821 BOX 22
FPO AE
09421
GB

V. Phone/Fax

Practice location:
  • Phone: 910-353-7357
  • Fax:
Mailing address:
  • Phone: 01895616389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number176505
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: