=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124849880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES A ATKINSON PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2024
-----------------------------------------------------
Last Update Date | 04/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44555 WOODWARD AVE SUITE 104
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-5032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-758-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 FRANK LLOYD WRIGHT DR SUITE J2000
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-747-6766
-----------------------------------------------------
Fax | 734-222-3100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5601012871
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------