Provider Demographics
NPI:1386093870
Name:ANDERSON, JAMES DEVANE (RRT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DEVANE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RRT
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 375
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-0375
Mailing Address - Country:US
Mailing Address - Phone:334-493-7081
Mailing Address - Fax:334-493-1525
Practice Address - Street 1:101 W COVINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-2032
Practice Address - Country:US
Practice Address - Phone:334-493-7081
Practice Address - Fax:334-493-1525
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL684227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009809650Medicaid
AL1162690001OtherPTAN
AL51032703OtherBLUE CROSS BLUE SHIELD