| Doctor Name: | TIM DAVIS |
| NPI Number: | 1619377199 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | R888378 |
| Business Practice Address: | 3102 Goodman Rd W Horn Lake, MS - 386371172 |
| Business Phone Number: | 6623426677 |
| Business Fax Number: | 6623421213 |
| Mailing Address: | 121 Angus Dr, TUPELO |
| State: | MS |
| Postal Code: | 388046102 |
| Phone Number: | 6622130042 |
| Fax Number: | |
| NPI Enumeration Date: | 09/03/2014 |
| NPI Last Update Date: | 04/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R888378 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |