Healthcare Provider Details

I. General information

NPI: 1619928827
Provider Name (Legal Business Name): JAMES HENRY MIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 ENTERPRISE PKWY SUITE 2200
HAMPTON VA
23666-6251
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-2170
  • Fax: 757-251-2185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101032906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: