Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1376 | SC |
NPI | 1134211261 |
---|---|
Provider Name | Dr. William Cleveland James JR. |
First Address | Columbia, SC 29204-3905 |
Second Address | Columbia, SC 29204-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |