Healthcare Provider Details

I. General information

NPI: 1275536567
Provider Name (Legal Business Name): JAMES T. MILAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EXCHANGE ST STE F
DANVILLE VA
24541-3500
US

IV. Provider business mailing address

110 EXCHANGE ST STE F
DANVILLE VA
24541-3500
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1562
  • Fax: 434-791-3776
Mailing address:
  • Phone: 434-791-1562
  • Fax: 434-791-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101048458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: