Individual
DR. JAMES NELSON MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 457-0469
Mailing address
205 S HIGHLAND WAY, MYRTLE BEACH, SC 29572-3362
(843) 457-4747
(843) 497-6405
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036082903
IL
207P00000X
Emergency Medicine Physician
16733
SC
207P00000X
Emergency Medicine Physician
Primary
62661
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167330
—
SC
Enumeration date
08/11/2006
Last updated
09/23/2021
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