MEDICARE: MR. JAMES F STEPHENS MA CCCA

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	231H00000X	Audiologist	438	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4630101	OTHER		INDEPENDENT LIVING
2	79722	OTHER	NC	BCBS
3	4630101	OTHER		VOC REHAB
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0184W	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1962430793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES F STEPHENS MA CCCA

Provider Business Mailing Address
First Line	:	2413 ROBESON STREET
Second Line	:	SUITE 2
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305
Country	:	US
Telephone Number	:	910-323-2616
Fax Number	:	910-323-9747

Provider Business Practice Location Address
First Line	:	2413 ROBESON STREET
Second Line	:	SUITE 2
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305
Country	:	US
Telephone Number	:	910-323-2616
Fax Number	:	910-323-9747

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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