Healthcare Provider Details

I. General information

NPI: 1790984185
Provider Name (Legal Business Name): CATHERINE DAVIS C.S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHADWICK DR
JACKSON MS
39204-3463
US

IV. Provider business mailing address

7 RIVERVIEW CV
BYRAM MS
39272-9106
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2999
  • Fax:
Mailing address:
  • Phone: 601-373-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3027
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: