Individual
JAY E DEVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OWNER
Contact information
Practice address
11 JOHN DAVENPORT DR NW, ROME, GA 30165-2509
(706) 290-7701
(706) 290-7702
Mailing address
11 JOHN DAVENPORT DR NW, ROME, GA 30165-2509
(706) 290-7701
(706) 290-7702
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
057-R-0017
GA
253Z00000X
In Home Supportive Care Agency
Primary
057-R00-17
GA
253Z00000X
In Home Supportive Care Agency
057R0017
GA
374U00000X
Home Health Aide
057-R-0017
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770031478
—
GA
Enumeration date
01/26/2022
Last updated
05/31/2023
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