1881949980 NPI number — QUALITY CARE SUPPORT COORDINATION

Table of content: MR. JAMISON EMILE DAVIS MAPC, LPC, NCC (NPI 1528269453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881949980 NPI number — QUALITY CARE SUPPORT COORDINATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY CARE SUPPORT COORDINATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881949980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2966 ELMORE PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLETT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38184-0439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2966 ELMORE PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLETT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38184-0439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-219-7138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GANT
Authorized Official First Name:
TAMEKA
Authorized Official Middle Name:
LATRICE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
901-219-7138

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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