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Individual

MR. JAMAAL LEE LEATHERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1011 PARK AVE, DURHAM, NC 27701-3548
(919) 381-6583
Mailing address
1011 PARK AVE, DURHAM, NC 27701-3548
(919) 381-6583

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-032-132
NC
320700000X
Physical Disabilities Residential Treatment Facility
FCL-032-132
NC
376G00000X
Nursing Home Administrator
FCL-032-132
NC

Other

Enumeration date
10/23/2013
Last updated
04/02/2014
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