Healthcare Provider Details

I. General information

NPI: 1164463568
Provider Name (Legal Business Name): JULIE ANNETTE MAYS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 N 5TH AVE STE 209
PHOENIX AZ
85013-3812
US

IV. Provider business mailing address

3411 N 5TH AVE STE 209
PHOENIX AZ
85013-3812
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-80
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2013-0007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: