Provider Demographics
NPI:1518428499
Name:MOORE, JAMES LAWRENCE JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:MOORE
Suffix:JR
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 1:1428 SUNFLOWER FIELD PL
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7623
Mailing Address - Country:US
Mailing Address - Phone:704-668-9195
Mailing Address - Fax:
Practice Address - Street 1:1428 SUNFLOWER FIELD PL
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-7623
Practice Address - Country:US
Practice Address - Phone:704-668-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC220005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner