Provider Demographics
NPI:1598545212
Name:DAVIS, JAZLYN AURELIA
Entity type:Individual
Prefix:
First Name:JAZLYN
Middle Name:AURELIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAZLYN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LABORATORY DIRECTOR
Mailing Address - Street 1:20490 BIRWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1002
Mailing Address - Country:US
Mailing Address - Phone:313-213-8514
Mailing Address - Fax:
Practice Address - Street 1:29777 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1303
Practice Address - Country:US
Practice Address - Phone:313-425-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy