Basic Information
| Provider Information | |||||||||
| NPI: | 1720089410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 PIEDMONT AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303032544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047565764 | ||||||||
| FaxNumber: | 4047565252 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 PIEDMONT AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303032544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047561480 | ||||||||
| FaxNumber: | 4047561489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 017852 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00083641BD | 05 | GA | MEDICAID |