Provider Demographics
NPI:1770251274
Name:DAVIS, JAMES COLEMAN JR (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:COLEMAN
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE FOREST LN
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35186-7317
Mailing Address - Country:US
Mailing Address - Phone:334-437-0263
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE FOREST LN
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:35186-7317
Practice Address - Country:US
Practice Address - Phone:334-437-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer