Basic Information
Provider Information
NPI: 1962603506
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DISNEY
FirstName: JAMES
MiddleName: ARTHUR
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 CABARRUS AVE E
Address2:  
City: CONCORD
State: NC
PostalCode: 280253699
CountryCode: US
TelephoneNumber: 8888497379
FaxNumber: 8558577333
Practice Location
Address1: 101 CABARRUS AVE E
Address2:  
City: CONCORD
State: NC
PostalCode: 280253699
CountryCode: US
TelephoneNumber: 8888497379
FaxNumber: 8558577333
Other Information
ProviderEnumerationDate: 05/30/2007
LastUpdateDate: 09/27/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X2010-01963NCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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