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General NPI Number Information
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NPI Number | 1215936844
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Entity Type | Individual
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Provider Name | JAMES DAVID MUCCIO MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 620 J L WHITE DR STE 100
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City | JASPER
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State | GA
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Zip | 30143-4897
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Country | US
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Telephone | 706-253-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 620 J L WHITE DR STE 100
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City | JASPER
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State | GA
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Zip | 30143-4897
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Country | US
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Telephone |
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35-07-8499
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 92222
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License Number State | GA
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