Basic Information
Provider Information | |||||||||
NPI: | 1972790640 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARLEY | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | KRISTIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HARLEY | ||||||||
OtherFirstName: | KRIS | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 2555 COURT DR | ||||||||
Address2: | SUITE 450 | ||||||||
City: | GASTONIA | ||||||||
State: | NC | ||||||||
PostalCode: | 280542134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7046717652 | ||||||||
FaxNumber: | 7046717656 | ||||||||
Practice Location | |||||||||
Address1: | 2555 COURT DR | ||||||||
Address2: | SUITE 450 | ||||||||
City: | GASTONIA | ||||||||
State: | NC | ||||||||
PostalCode: | 280542134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7046717652 | ||||||||
FaxNumber: | 7046717656 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2007 | ||||||||
LastUpdateDate: | 02/20/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | TL1652 | SC | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | TL1652 | SC | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 2013-02504 | NC | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.