Provider Demographics
NPI:1811696990
Name:DAVIS, JAMAL ISIAH
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:ISIAH
Last Name:DAVIS
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 1:1243 STONE RIDGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4146
Mailing Address - Country:US
Mailing Address - Phone:614-264-3539
Mailing Address - Fax:
Practice Address - Street 1:1243 STONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4146
Practice Address - Country:US
Practice Address - Phone:614-264-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health