1447555255 NPI number — SARAH ELIZABETH DAVIS MT-BC, TEACHING CERT

Table of content: SARAH ELIZABETH DAVIS MT-BC, TEACHING CERT (NPI 1447555255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447555255 NPI number — SARAH ELIZABETH DAVIS MT-BC, TEACHING CERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
SARAH
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT-BC, TEACHING CERT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
SARAH
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447555255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 BROOKMEADE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37334-2051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-433-1265
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 DAVIDSON ST.
Provider Second Line Business Practice Location Address:
CENTERSTONE OF TENNESSEE, INC
Provider Business Practice Location Address City Name:
TULLAHOMA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-463-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2011

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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