Provider Demographics
NPI:1194899617
Name:MARNOCK, JAMES JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
Last Name:MARNOCK
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:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5698
Mailing Address - Fax:
Practice Address - Street 1:15 JANE JACOBS RD STE 101
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-8308
Practice Address - Country:US
Practice Address - Phone:828-298-0333
Practice Address - Fax:828-298-0050
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790101YMedicaid
NC080127240OtherPALMETTO GBA-RAILROAD MED
NC54940OtherBCBS OF NC -INDIVIDUAL
NC0101YOtherBCBS OF NC-PRACTICE #
NC56-2093810OtherUNITED HEALTHCARE #
NC8954940Medicaid