1417355405 NPI number — CHRISTOPHER EVERETT DAVIS DPT

Table of content: (NPI 1629448428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417355405 NPI number — CHRISTOPHER EVERETT DAVIS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1417355405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8823 PRODUCTION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7217
Provider Business Mailing Address Fax Number:
423-238-3473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 MONTEVALLO RD
Provider Second Line Business Practice Location Address:
STE B108
Provider Business Practice Location Address City Name:
IRONDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35210-3129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-957-0870
Provider Business Practice Location Address Fax Number:
205-957-0872
Provider Enumeration Date:
12/08/2014

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: 225100000X , with the licence number:  PTH7481 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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