| Doctor Name: | NATHAN LOGAN DAVIS |
| NPI Number: | 1063844066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | IN0006768 |
| Business Practice Address: | 5706 Medical Ctr Dr Wvu School Of Pharmacy Morgantown, WV - 26505 |
| Business Phone Number: | 3045189963 |
| Business Fax Number: | |
| Mailing Address: | 966 Valley View Ave, Apt F MORGANTOWN |
| State: | WV |
| Postal Code: | 265051817 |
| Phone Number: | 3045189963 |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2013 |
| NPI Last Update Date: | 08/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | IN0006768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |