=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285736702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES DANIEL DILLON JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2006
-----------------------------------------------------
Last Update Date | 01/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 UNIVERSITY PKWY STE 1520
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29801-6840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-502-8400
-----------------------------------------------------
Fax | 803-641-7015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 367 S GULPH RD ATTN IPM CREDENTIALING
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-502-9400
-----------------------------------------------------
Fax | 803-641-7015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 632617
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 32617
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------