Healthcare Provider Details

I. General information

NPI: 1134712276
Provider Name (Legal Business Name): JIHAD DAVIS MA, DP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 READING AVE
JONESVILLE MI
49250-1136
US

IV. Provider business mailing address

110 READING AVE
JONESVILLE MI
49250-1136
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-2330
  • Fax: 517-849-2906
Mailing address:
  • Phone: 517-849-2330
  • Fax: 517-849-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: