Healthcare Provider Details

I. General information

NPI: 1598545212
Provider Name (Legal Business Name): JAZLYN AURELIA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAZLYN DAVIS LABORATORY DIRECTOR

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 11/04/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29777 TELEGRAPH RD
SOUTHFIELD MI
48034-1303
US

IV. Provider business mailing address

20490 BIRWOOD ST
DETROIT MI
48221-1002
US

V. Phone/Fax

Practice location:
  • Phone: 313-425-1520
  • Fax:
Mailing address:
  • Phone: 313-213-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: