MEDICARE: JAMES LEWIS MAYNARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7316	SC
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	7316	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27689	OTHER		MEDCOST

General Provider Information

NPI Number	:	1679565196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEWIS MAYNARD MD

Provider Business Mailing Address
First Line	:	PO BOX 6426
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24068-6426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S HERLONG AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1158
Country	:	US
Telephone Number	:	803-329-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	02/20/2012

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