Doctor Name: | MR. TERRY G DAVIS |
NPI Number: | 1114993904 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA00485 |
Business Practice Address: | Blanchfield Army Community Hospital 650 Joel Dr. Fort Campbell, KY - 42223 |
Business Phone Number: | 2707988372 |
Business Fax Number: | |
Mailing Address: | Blanchfield Army Community Hospital, 650 Joel Dr. FORT CAMPBELL |
State: | KY |
Postal Code: | 42223 |
Phone Number: | 2707988372 |
Fax Number: | |
NPI Enumeration Date: | 02/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | PA00485 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |