Provider Demographics
NPI:1104119205
Name:POINDEXTER, JAMES JERRELL
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JERRELL
Last Name:POINDEXTER
Suffix:
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 1:1261 MAZUREK BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3980
Mailing Address - Country:US
Mailing Address - Phone:850-287-5362
Mailing Address - Fax:
Practice Address - Street 1:1261 MAZUREK BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-3980
Practice Address - Country:US
Practice Address - Phone:850-287-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical