Provider Demographics
NPI:1225434848
Name:DAVIS, JACKSON LEE III (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:LEE
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 MINNESOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3572
Mailing Address - Country:US
Mailing Address - Phone:202-388-6000
Mailing Address - Fax:202-388-6001
Practice Address - Street 1:4121 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3572
Practice Address - Country:US
Practice Address - Phone:202-388-6000
Practice Address - Fax:202-388-6001
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0378022083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine