Provider Demographics
NPI:1104801950
Name:DYE, JAMES W (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:DYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WADE
Other - Middle Name:
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-2007
Mailing Address - Country:US
Mailing Address - Phone:912-283-7951
Mailing Address - Fax:912-285-7922
Practice Address - Street 1:1306 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4527
Practice Address - Country:US
Practice Address - Phone:912-283-7951
Practice Address - Fax:912-285-7922
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034129208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456156AMedicaid
GA10057862OtherAMERIGROUP
GA300020047CMedicaid
GA340003981OtherRAILROAD MEDICARE
GA339931OtherWELLCARE
GA024623OtherBLUE CROSS BLUE SHIELD
GA340003981OtherRAILROAD MEDICARE
GAE81659Medicare UPIN
GA34BDBLXMedicare ID - Type Unspecified
GA34BDBLXMedicare PIN