MEDICARE: MR. TIMOTHY ROBERT DAVIS CRT

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
1	2278H0200X	Home Health Certified Respiratory Therapist	005147	GA

General Provider Information

NPI Number	:	1811990278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY ROBERT DAVIS CRT

Provider Business Mailing Address
First Line	:	3765 TEDS CV
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-8432
Country	:	US
Telephone Number	:	404-468-8370
Fax Number	:	678-348-7574

Provider Business Practice Location Address
First Line	:	3765 TEDS CV
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-8432
Country	:	US
Telephone Number	:	404-468-8370
Fax Number	:	678-348-7574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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