Individual
MR. JEROME DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3209 W APOLLO RD, PHOENIX, AZ 85041-6338
(623) 853-7881
Mailing address
4449 N 12TH ST, PHOENIX, AZ 85014-4520
(602) 279-1427
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992254338
—
AZ
Enumeration date
08/07/2014
Last updated
04/19/2023
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