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General NPI Number Information
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NPI Number | 1124172986
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Entity Type | Individual
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Provider Name | MR. JAMES EDWARD MCIVER JR.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 141 THOMAS HUMPHREY RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6205
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Country | US
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Telephone | 910-347-5218
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Fax | 910-346-0957
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Provider Business Mailing Address
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Address Line | PO BOX 12364
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City | JACKSONVILLE
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State | NC
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Zip | 28546-2364
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Country | US
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Telephone | 910-347-5218
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Fax | 910-346-0957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-067-142
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-067-162
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License Number State | NC
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