Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | T-3105 | MS |
Y | 111NI0900X | Internist | T-3105 | MS |
NPI | 1003268079 |
---|---|
Provider Name | Dr. Joshua Lane Davis |
First Address | Corinth, MS 38834-9321 |
Second Address | Corinth, MS 38834-9321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 01/07/2016 |