Basic Information
Provider Information | |||||||||
NPI: | 1477515195 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RADFORD | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | EARL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 800 N JUSTICE ST # 16 | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 287913410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286948385 | ||||||||
FaxNumber: | 8286947654 | ||||||||
Practice Location | |||||||||
Address1: | 805 6TH AVE W STE 100 | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 28739 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286928045 | ||||||||
FaxNumber: | 8286926630 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2006 | ||||||||
LastUpdateDate: | 03/31/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/31/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 9401308 | NC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 7969911 | 05 | NC |   | MEDICAID | 2205876C | 01 | NC | MEDICARE PTAN | OTHER |