Healthcare Provider Details

I. General information

NPI: 1346886496
Provider Name (Legal Business Name): JAMES EDWARD NEWTON COF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S HERLONG AVE STE 110
ROCK HILL SC
29732-1089
US

IV. Provider business mailing address

223 S HERLONG AVE STE 110
ROCK HILL SC
29732-1089
US

V. Phone/Fax

Practice location:
  • Phone: 803-980-5080
  • Fax: 803-980-5083
Mailing address:
  • Phone: 803-980-5080
  • Fax: 803-980-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC16055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: