Healthcare Provider Details

I. General information

NPI: 1114728987
Provider Name (Legal Business Name): SAVANNAH DAVIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 MAIN ST
VILONIA AR
72173-8072
US

IV. Provider business mailing address

1260 HIGHWAY 5
ROMANCE AR
72136-9618
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-9278
  • Fax: 501-421-2350
Mailing address:
  • Phone: 228-224-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: