Provider Demographics
NPI:1447361241
Name:ANDERSON, JAMES L III (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 INNOVATION DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5261
Mailing Address - Country:US
Mailing Address - Phone:864-295-1750
Mailing Address - Fax:864-295-1753
Practice Address - Street 1:2 INNOVATION DR
Practice Address - Street 2:SUITE 140
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-295-1750
Practice Address - Fax:864-295-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-06-29
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Provider Licenses
StateLicense IDTaxonomies
SC7401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962656892Medicaid
SC1962656892Medicaid
1962656892Medicare PIN