1316176050 NPI number — THOMAS E. DAVIS, MD, PLLC

Table of content: (NPI 1316176050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316176050 NPI number — THOMAS E. DAVIS, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
THOMAS E. DAVIS, MD, PLLC
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:
1316176050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4295 CROMWELL RD
Provider Second Line Business Mailing Address:
STE. 308
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-2166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-877-2312
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-3398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-698-0221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-827-4393

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  36302 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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