Provider Demographics
NPI:1366091563
Name:DAVIS, JEFFERY ALAN
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128-2021
Mailing Address - Country:US
Mailing Address - Phone:804-815-2350
Mailing Address - Fax:
Practice Address - Street 1:615 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:VA
Practice Address - Zip Code:23128-2021
Practice Address - Country:US
Practice Address - Phone:804-815-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider