Healthcare Provider Details

I. General information

NPI: 1902725146
Provider Name (Legal Business Name): JAMES RICHARD DAVIS JR. PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 12TH STREET EXT
PRINCETON WV
24740-2398
US

IV. Provider business mailing address

900 HIGHLAND AVE
BLUEFIELD WV
24701-2729
US

V. Phone/Fax

Practice location:
  • Phone: 681-282-5605
  • Fax:
Mailing address:
  • Phone: 681-282-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: