Provider Demographics
NPI:1407364037
Name:MCCOY, JAMAL EVERETTE I
Entity Type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:EVERETTE
Last Name:MCCOY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 WESTOVER HILLS BLVD APT L
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4589
Mailing Address - Country:US
Mailing Address - Phone:910-978-1336
Mailing Address - Fax:
Practice Address - Street 1:643 WESTOVER HILLS BLVD APT L
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4589
Practice Address - Country:US
Practice Address - Phone:910-978-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker