Provider Demographics
NPI:1386443992
Name:DAVIS, JACOB HUNTER
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:HUNTER
Last Name:DAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 COURTYARD LN
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-3512
Mailing Address - Country:US
Mailing Address - Phone:423-494-0591
Mailing Address - Fax:
Practice Address - Street 1:804 COURTYARD LN
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-3512
Practice Address - Country:US
Practice Address - Phone:423-494-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant