Provider Demographics
NPI:1619564325
Name:ANTHONY, JERMAINE LEE
Entity Type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:LEE
Last Name:ANTHONY
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 1:2120 MAPLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2142
Mailing Address - Country:US
Mailing Address - Phone:330-209-8640
Mailing Address - Fax:
Practice Address - Street 1:2120 MAPLE AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2142
Practice Address - Country:US
Practice Address - Phone:330-209-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health