Provider Demographics
NPI:1972297489
Name:PIERCE, JAMES WALLACE IV (MT-BC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:PIERCE
Suffix:IV
Gender:M
Credentials:MT-BC
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:WALLACE
Other - Last Name:PIERCE
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC
Mailing Address - Street 1:3917 AUGUST MOON CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-4231
Mailing Address - Country:US
Mailing Address - Phone:901-356-4010
Mailing Address - Fax:
Practice Address - Street 1:3917 AUGUST MOON CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-4231
Practice Address - Country:US
Practice Address - Phone:901-356-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07435225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist