Individual
JUSTIN RYAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12561 WARDLINE RD, HAMMOND, LA 70401-6212
(985) 520-5697
Mailing address
PO BOX 2162, HAMMOND, LA 70404-2162
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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