Basic Information
| Provider Information | |||||||||
| NPI: | 1073951646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COKLEY | ||||||||
| FirstName: | JAMI | ||||||||
| MiddleName: | DAVINA | ||||||||
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| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5158 | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293045158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645822817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 362 N PINE ST | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293021631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643984185 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 8344 | SC | Y | Dental Providers | Dentist | General Practice |
No ID Information.