Healthcare Provider Details

I. General information

NPI: 1003262551
Provider Name (Legal Business Name): JAMES PERRY MAYO III M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 NAVAHO TRL UNIT 107
WILMINGTON NC
28409-3325
US

IV. Provider business mailing address

1426 NAVAHO TRL UNIT 107
WILMINGTON NC
28409-3325
US

V. Phone/Fax

Practice location:
  • Phone: 910-518-8807
  • Fax: 910-216-4278
Mailing address:
  • Phone: 910-518-8807
  • Fax: 910-216-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218265
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number218265
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberT9949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: