Healthcare Provider Details

I. General information

NPI: 1770297749
Provider Name (Legal Business Name): JAMES OSCAR GWINN PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 PRINCE ST STE 1
BECKLEY WV
25801-4515
US

IV. Provider business mailing address

PO BOX 46
MABSCOTT WV
25871-0046
US

V. Phone/Fax

Practice location:
  • Phone: 304-731-0925
  • Fax:
Mailing address:
  • Phone: 304-731-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number22-9307
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: