1407836349 NPI number — JAMES W HOLCOMB M.D.

Table of content: JAMES W HOLCOMB M.D. (NPI 1407836349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407836349 NPI number — JAMES W HOLCOMB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLCOMB
Provider First Name:
JAMES
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407836349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 15TH ST
Provider Second Line Business Mailing Address:
BIW-6033
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30912-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-721-2331
Provider Business Mailing Address Fax Number:
706-721-7531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 15TH ST
Provider Second Line Business Practice Location Address:
BIW-6033
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30912-0004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-721-2331
Provider Business Practice Location Address Fax Number:
706-721-7531
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  027065 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1831207 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 340850 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10045040 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 370019337 . This is a "RR MEDICARE-GRP # CC4177" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4700072 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52045639 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000325289Q , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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