Healthcare Provider Details

I. General information

NPI: 1992975460
Provider Name (Legal Business Name): JAMES R DEVILLIER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RIDGE RD
ROXBORO NC
27573-4629
US

IV. Provider business mailing address

296 DENADA PATH
ROXBORO NC
27574-6306
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9440
  • Fax: 336-659-9845
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9500554
License Number StateNC

VIII. Authorized Official

Name: DR. JAMES DEVILLIER
Title or Position: OWNER
Credential: MD
Phone: 336-659-9440