1205927795 NPI number — MR. JON DANIEL DAVIS MSW, LCSW, LICSW

Table of content: MR. JON DANIEL DAVIS MSW, LCSW, LICSW (NPI 1205927795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205927795 NPI number — MR. JON DANIEL DAVIS MSW, LCSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
JON
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, LICSW
Provider Gender Code:
M

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:
1205927795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAMEDDAC WUERZBURG, ATTN: CREDENTIALS OFFICE
Provider Second Line Business Mailing Address:
UNIT 26610
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09244-6610
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
011499318043616
Provider Business Mailing Address Fax Number:
011499318043241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAMEDDAC WUERZBURG, ATTN: CREDENTIALS OFFICE
Provider Second Line Business Practice Location Address:
UNIT 26610
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09244-6610
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011499318043616
Provider Business Practice Location Address Fax Number:
011499318043241
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  120298-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: LW00006172 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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