Provider Demographics
NPI:1063091791
Name:DAVIS, JOSEPH JR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DAVIS
Suffix:JR
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 1:17451 OMEGA CT
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-1534
Mailing Address - Country:US
Mailing Address - Phone:225-266-1037
Mailing Address - Fax:
Practice Address - Street 1:17451 OMEGA CT
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-1534
Practice Address - Country:US
Practice Address - Phone:225-266-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA23691221Medicaid