Healthcare Provider Details

I. General information

NPI: 1548203425
Provider Name (Legal Business Name): JAMES JAY NOCKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E BALTIMORE PIKE
KENNETT SQUARE PA
19348-1800
US

IV. Provider business mailing address

920 E BALTIMORE PIKE
KENNETT SQUARE PA
19348-1800
US

V. Phone/Fax

Practice location:
  • Phone: 610-388-7407
  • Fax:
Mailing address:
  • Phone: 610-388-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME123861
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0053139
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD011165E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: