Healthcare Provider Details

I. General information

NPI: 1003056789
Provider Name (Legal Business Name): HARRY DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1817
CHICAGO IL
60602-1807
US

IV. Provider business mailing address

2300 N HERRITAGE ST
KINSTON NC
28501-1651
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-6966
  • Fax: 636-397-6836
Mailing address:
  • Phone: 252-285-5098
  • Fax: 561-688-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1542
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: