Provider Demographics
NPI:1215083563
Name:PRIDGEN, JAMES HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:PRIDGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:308 US HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7828
Mailing Address - Country:US
Mailing Address - Phone:910-329-1707
Mailing Address - Fax:910-329-1716
Practice Address - Street 1:614 N JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3008
Practice Address - Country:US
Practice Address - Phone:910-640-2009
Practice Address - Fax:910-640-3036
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29495207Q00000X, 207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7969223Medicaid
NCC86062Medicare UPIN
NC209723ZMedicare PIN
NC209723RMedicare ID - Type UnspecifiedMEDICARE
209723WMedicare PIN
NC2021842Medicare PIN
NC2021792Medicare PIN
209723UMedicare PIN