Healthcare Provider Details

I. General information

NPI: 1053564237
Provider Name (Legal Business Name): JAMIE DAMCOTT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 INTERSTATE CIR
PENSACOLA FL
32526-9259
US

IV. Provider business mailing address

6402 MEADOW FIELD CIR
PENSACOLA FL
32526-5103
US

V. Phone/Fax

Practice location:
  • Phone: 850-207-9878
  • Fax:
Mailing address:
  • Phone: 850-207-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number396913
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: