Basic Information
| Provider Information | |||||||||
| NPI: | 1639183700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 N CEDAR ST STE B | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102723048 | ||||||||
| FaxNumber: | 9107383764 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 OAKRIDGE BLVD STE B2 | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106710052 | ||||||||
| FaxNumber: | 9106719157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200601217 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5904568 | 05 | NC | MEDICAID | 144WY | 01 | NC | BCBS | OTHER |