Healthcare Provider Details

I. General information

NPI: 1285953109
Provider Name (Legal Business Name): JACOB STEPHENS MAYS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 N BUSINESS DR STE 104
FAYETTEVILLE AR
72703-5287
US

IV. Provider business mailing address

7603 TISDALE DR
AUSTIN TX
78757-1440
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-1532
  • Fax:
Mailing address:
  • Phone: 817-733-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-10131
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ1221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: