Healthcare Provider Details

I. General information

NPI: 1760454474
Provider Name (Legal Business Name): JAMES EDWARD JEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MOORE RD
KING NC
27021-8703
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-983-4346
  • Fax: 336-985-5101
Mailing address:
  • Phone: 336-983-4346
  • Fax: 336-985-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800922
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9800922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: