Individual
DR. JAMES ROY CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 R T STANLEY SR PLACE, LYONS, GA 30436-5623
(912) 526-9355
(912) 526-8622
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 526-9355
(912) 526-8622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
050608
GA
207Q00000X
Family Medicine Physician
2016-01953
NC
207Q00000X
Family Medicine Physician
39184
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548250830
—
NC
05
—
G50608
—
SC
01
—
P01701620
RAILROAD MEDICARE
SC
Enumeration date
10/27/2005
Last updated
10/17/2019
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