Healthcare Provider Details

I. General information

NPI: 1528384195
Provider Name (Legal Business Name): JARED MICHAEL DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 315
JACKSON MS
39216-4607
US

IV. Provider business mailing address

PO BOX 12373
JACKSON MS
39236-2373
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-9530
  • Fax: 601-206-0153
Mailing address:
  • Phone: 601-414-9530
  • Fax: 601-206-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25889
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: