Healthcare Provider Details

I. General information

NPI: 1952347726
Provider Name (Legal Business Name): JAMES MAXWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 MAIN ST
WADE NC
28395-9749
US

IV. Provider business mailing address

PO BOX 449
WADE NC
28395-0449
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-6694
  • Fax: 910-483-2215
Mailing address:
  • Phone: 910-483-6694
  • Fax: 910-483-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9300534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: