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General NPI Number Information
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NPI Number | 1952061657
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Entity Type | Individual
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Provider Name | JAMES MATTHEW DILLESHAW FNP
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Gender | Male
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 2430 REIDVILLE RD STE 103
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City | SPARTANBURG
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State | SC
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Zip | 29301-3652
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Country | US
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Telephone | 864-272-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W SAINT JOHN ST STE 107
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City | SPARTANBURG
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State | SC
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Zip | 29306-5157
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Country | US
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Telephone | 864-342-7070
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25680
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License Number State | SC
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