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NPI Code Detail

MEDICARE: MR. JEFFREY DAVIS LMSW

MEDICARE: MR. JEFFREY DAVIS LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801067616MI

General Provider Information

NPI Number : 1023550779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY DAVIS LMSW
Provider Business Mailing Address
First Line : 905 W BURNSIDE ST
Second Line :
City : CARO
State : MI
Zip : 48723-1488
Country : US
Telephone Number : 989-751-5300
Fax Number :
Provider Business Practice Location Address
First Line : 6627 ROSE ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1262
Country : US
Telephone Number : 989-872-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2016
Last Update Date : 11/12/2016

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Directions to “ MR. JEFFREY DAVIS LMSW” Practice Location

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