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General NPI Number Information
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NPI Number | 1619534518
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Entity Type | Individual
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Provider Name | MR. JIMMIE LEE DAVIS JR.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2019
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Last Update Date | 05/26/2019
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Provider Practice Location Address
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Address Line | 505 S TIMBERLAND DR
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City | LUFKIN
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State | TX
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Zip | 75901-4084
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Country | US
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Telephone | 936-671-0996
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Fax |
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Provider Business Mailing Address
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Address Line | 607 BURTON AVE
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City | LUFKIN
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State | TX
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Zip | 75904-4665
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Country | US
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Telephone | 936-671-0996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 1180376
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License Number State | TX
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