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General NPI Number Information
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NPI Number | 1508819269
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Entity Type | Individual
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Provider Name | JAMES LEWIS FENLEY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 2583 S VOLUSIA AVE STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-9129
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Country | US
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Telephone | 386-960-7830
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Fax | 386-960-7833
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Provider Business Mailing Address
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Address Line | 2583 S VOLUSIA AVE STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-9129
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Country | US
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Telephone | 386-960-7830
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Fax | 386-960-7833
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | ME127760
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 034584
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME127760
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License Number State | FL
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