Provider Demographics
NPI:1407409105
Name:DAVIS, JERAMIE
Entity Type:Individual
Prefix:
First Name:JERAMIE
Middle Name:
Last Name:DAVIS
Suffix:
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 1:5170 E 65TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4992
Mailing Address - Country:US
Mailing Address - Phone:317-986-6755
Mailing Address - Fax:
Practice Address - Street 1:2829 GREENVIEW WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-1500
Practice Address - Country:US
Practice Address - Phone:317-650-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator