Provider Demographics
NPI:1871006924
Name:OLIVER, JAMA'L (MASTER BARBER)
Entity Type:Individual
Prefix:
First Name:JAMA'L
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MASTER BARBER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 TYNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5285
Mailing Address - Country:US
Mailing Address - Phone:931-896-9533
Mailing Address - Fax:
Practice Address - Street 1:2038 TYNEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5285
Practice Address - Country:US
Practice Address - Phone:931-896-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty