=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912835356
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JAMES ANDERSON II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2026
-----------------------------------------------------
Last Update Date | 05/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 EAGLESTON DR
-----------------------------------------------------
City | MONCKS CORNER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29461-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-925-1059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 EAGLESTON DR
-----------------------------------------------------
City | MONCKS CORNER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29461-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-925-1059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | SC014744
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------