Doctor Name: | LORA D DAVIS |
NPI Number: | 1992823082 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 12478 |
Business Practice Address: | 224 Old Mill Rd Wartburg, TN - 378874163 |
Business Phone Number: | 4233466221 |
Business Fax Number: | 4233465565 |
Mailing Address: | Po Box 408, WARTBURG |
State: | TN |
Postal Code: | 378870408 |
Phone Number: | 4233466221 |
Fax Number: | 4233465565 |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 02/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 12478 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |