Provider Demographics
NPI:1811021074
Name:DAMRON, JIMMY DAVID (DPH)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:DAVID
Last Name:DAMRON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 TAURUS DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9468
Mailing Address - Country:US
Mailing Address - Phone:256-852-1137
Mailing Address - Fax:
Practice Address - Street 1:106 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3050
Practice Address - Country:US
Practice Address - Phone:931-433-1511
Practice Address - Fax:931-433-6854
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist