Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 2462 | SC |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2462 | SC |
N | 225400000X | Rehabilitation Practitioner | 2462 | SC |
NPI | 1467441626 |
---|---|
Provider Name | Dr. James Michael Prevost |
First Address | Shelby, NC 28150-3487 |
Second Address | Shelby, NC 28150-3487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 29/12/2021 |