Provider Demographics
NPI:1154101251
Name:DOAK, JAMIE
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:DOAK
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:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-0852
Mailing Address - Country:US
Mailing Address - Phone:330-235-3353
Mailing Address - Fax:
Practice Address - Street 1:4247 DUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9475
Practice Address - Country:US
Practice Address - Phone:330-235-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider