Provider Demographics
NPI:1194709576
Name:MIMS, JAMES WHITMAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WHITMAN
Last Name:MIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1332
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-9440
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000902207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6500846Medicaid
NC36194OtherPARTNERS
SCQ0090OMedicaid
NC89126KKMedicaid
7768302OtherAETNA
NC126KKOtherBCBS
NC98105OtherMEDCOST
WV3004496000Medicaid
NC36194OtherPARTNERS
NC2280485AMedicare PIN