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General NPI Number Information
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NPI Number | 1720017346
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Entity Type | Individual
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Provider Name | JAMES R STALLWORTH MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 14 MEDICAL PARK RD SUITE 400
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City | COLUMBIA
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State | SC
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Zip | 29203-6877
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Country | US
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Telephone | 803-255-3422
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Fax | 803-255-3451
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Provider Business Mailing Address
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Address Line | PO BOX 743904
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City | ATLANTA
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State | GA
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Zip | 30374-3904
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Country | US
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Telephone | 803-293-7320
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Fax | 803-296-7330
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9582
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License Number State | SC
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