Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 3905 | TN |
NPI | 1225484561 |
---|---|
Provider Name | Billy Davis |
First Address | Vestavia, AL 35242-2584 |
Second Address | Jackson, TN 38305-2089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 01/06/2021 |