Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 18218 | MS |
NPI | 1184755308 |
---|---|
Provider Name | Amy B Davis |
First Address | Corinth, MS 38834-9073 |
Second Address | Corinth, MS 38834-6026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 17/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08033823 | (05) | MS |
H99532 | (02) | MS |