Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 273486 | MA |
N | 111NI0900X | Internist | 273486 | MA |
N | 207RC0200X | Critical Care Medicine | 57595 | TN |
Y | 207RP1001X | Pulmonary Disease | 57595 | TN |
NPI | 1053738336 |
---|---|
Provider Name | Jonathan M. Davis |
First Address | Memphis, TN 38120-2125 |
Second Address | Memphis, TN 38120-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 03/08/2021 |