Provider Demographics
NPI:1356778781
Name:BOSARGE, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BOSARGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:PERKINSTON
Mailing Address - State:MS
Mailing Address - Zip Code:39573-3383
Mailing Address - Country:US
Mailing Address - Phone:228-860-7841
Mailing Address - Fax:
Practice Address - Street 1:50141 VOTECH RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-9029
Practice Address - Country:US
Practice Address - Phone:662-369-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty