Healthcare Provider Details

I. General information

NPI: 1235320235
Provider Name (Legal Business Name): JULIANA BROOK DAVIS TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 W MAIN ST STE 3
JACKSONVILLE AR
72076-4207
US

IV. Provider business mailing address

2227 W MAIN ST STE 3
JACKSONVILLE AR
72076-4207
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-9944
  • Fax: 501-985-6590
Mailing address:
  • Phone: 501-985-9944
  • Fax: 501-985-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: