Provider Demographics
NPI:1841257540
Name:COSTNER, JAMES MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MITCHELL
Last Name:COSTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:214 N. CLEVELAND AVE.
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3106
Mailing Address - Country:US
Mailing Address - Phone:704-730-1228
Mailing Address - Fax:704-730-1231
Practice Address - Street 1:214 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3106
Practice Address - Country:US
Practice Address - Phone:704-730-1228
Practice Address - Fax:704-730-1231
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9400760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8924631Medicaid
NC1841257540Medicaid
NC2200523AMedicare PIN
NC2200523BMedicare PIN
NC8924631Medicaid
NC2200523Medicare PIN