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NPI Code Detail

MEDICARE: MRS. CAITLYN DAVIS

MEDICARE: MRS. CAITLYN DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant4797TN

General Provider Information

NPI Number : 1013679018
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAITLYN DAVIS
Provider Business Mailing Address
First Line : 200 MARINA DR
Second Line :
City : CLINTON
State : TN
Zip : 37716-5980
Country : US
Telephone Number : 865-599-6385
Fax Number :
Provider Business Practice Location Address
First Line : 1825 KNOXVILLE HWY
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4120
Country : US
Telephone Number : 423-346-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2021
Last Update Date : 03/27/2023

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Directions to “ MRS. CAITLYN DAVIS ” Practice Location

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