NPIMap

Organization Active NPI

James D Douglass DDS PA

  • General Practice Dentistry
  • Fayetteville, NC
National Provider Identifier
1306902416
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3344 Issued in NC
Legal business name
JAMES D DOUGLASS DDS PA
Practice address
101 Wall St
Fayetteville, NC 28301-4761
Phone
(910) 323-8254
Fax
(910) 323-2532
NPI assigned
Jan 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James Davis Douglass Jr., DDSNPI 1124184239
Title
Owner
Phone
(910) 323-8254

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 3344 NC Primary

Addresses

Primary practice location

101 Wall St
Fayetteville, NC 28301-4761

Mailing address

PO Box 1449
Fayetteville, NC 28302-1449
Phone (910) 323-8254

Other identifiers 3

IdentifierTypeStateIssuer
5950576MedicaidNC
809135OtherNCUNITED CONCORDIA
92191OtherNCBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

101 Wall St
Fayetteville, NC 28301
Phone (910) 323-8254

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1306902416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283021449",
            "telephone_number": "910-323-8254",
            "fax_number": "910-323-2532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WALL ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014761",
            "telephone_number": "910-323-8254",
            "fax_number": "910-323-2532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES D DOUGLASS DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-01",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-323-8254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "3344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950576",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "809135",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "92191",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.