Provider Demographics
NPI:1235320235
Name:DAVIS, JULIANA BROOK (TECHNICIAN)
Entity Type:Individual
Prefix:MS
First Name:JULIANA
Middle Name:BROOK
Last Name:DAVIS
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 W MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4207
Mailing Address - Country:US
Mailing Address - Phone:501-985-9944
Mailing Address - Fax:501-985-6590
Practice Address - Street 1:2227 W MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4207
Practice Address - Country:US
Practice Address - Phone:501-985-9944
Practice Address - Fax:501-985-6590
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146940002Medicaid
AR5C724OtherIDTF
OK400522335OtherMEDICARE ID
OK400522327OtherIDTF
AR5C652OtherMEDICARE ID