Healthcare Provider Details

I. General information

NPI: 1407237365
Provider Name (Legal Business Name): WILLIAM DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 S GREEN ST
TUPELO MS
38804-6556
US

IV. Provider business mailing address

401 ALCORN DR STE 2C
CORINTH MS
38834-9073
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-2189
  • Fax: 662-377-2667
Mailing address:
  • Phone: 662-293-7266
  • Fax: 662-293-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24691
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: