Provider Demographics
NPI:1083930580
Name:DAVID, JAMALIA JUNELLE (MD)
Entity Type:Individual
Prefix:
First Name:JAMALIA
Middle Name:JUNELLE
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4375
Mailing Address - Country:US
Mailing Address - Phone:704-226-5013
Mailing Address - Fax:704-296-4172
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4375
Practice Address - Country:US
Practice Address - Phone:704-226-5013
Practice Address - Fax:704-296-4172
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine