Healthcare Provider Details

I. General information

NPI: 1215083563
Provider Name (Legal Business Name): JAMES HENRY PRIDGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N JK POWELL BLVD
WHITEVILLE NC
28472-3008
US

IV. Provider business mailing address

119 HOLLY ST
HOLLY RIDGE NC
28445-7898
US

V. Phone/Fax

Practice location:
  • Phone: 910-640-2009
  • Fax: 910-640-3036
Mailing address:
  • Phone: 910-329-1707
  • Fax: 910-329-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29495
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29495
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29495
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: