Basic Information
Provider Information
NPI: 1003006206
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIS
FirstName: LAMAR
MiddleName:  
NamePrefix:  
NameSuffix: II
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 N STATE ST
Address2:  
City: JACKSON
State: MS
PostalCode: 392164505
CountryCode: US
TelephoneNumber: 6019845275
FaxNumber:  
Practice Location
Address1: 2500 N STATE ST
Address2:  
City: JACKSON
State: MS
PostalCode: 39216
CountryCode: US
TelephoneNumber: 6019845275
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 04/23/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0402X307056LAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
2084N0402X20797MSN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology

ID Information
IDTypeStateIssuerDescription
0312285905MS MEDICAID


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