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General NPI Number Information
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NPI Number | 1952487936
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Entity Type | Individual
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Provider Name | JAMES COLE PA
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 101 S. LIBERTY STREET
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City | RUSSIAVILLE
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State | IN
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Zip | 46979
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Country | US
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Telephone | 765-883-2273
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Fax | 765-883-5168
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Provider Business Mailing Address
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Address Line | 3660 HOWELL FERRY RD BLDG B
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City | DULUTH
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State | GA
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Zip | 30096-3178
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Country | US
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Telephone | 765-883-2273
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Fax | 765-883-5168
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000210
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License Number State | IN
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