Provider Demographics
NPI:1538218649
Name:JAMES, JOHNNIE EUGENE (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:EUGENE
Last Name:JAMES
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1181
Mailing Address - Country:US
Mailing Address - Phone:563-359-3012
Mailing Address - Fax:563-333-6239
Practice Address - Street 1:518 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2829
Practice Address - Country:US
Practice Address - Phone:563-333-6062
Practice Address - Fax:563-333-6239
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer