Provider Demographics
NPI:1659075646
Name:DAVIS, JAMIE LEE (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37457 STATE ROUTE 558 LOT 70
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9774
Mailing Address - Country:US
Mailing Address - Phone:234-567-6197
Mailing Address - Fax:
Practice Address - Street 1:37457 STATE ROUTE 558 LOT 70
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-9774
Practice Address - Country:US
Practice Address - Phone:234-567-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health