Healthcare Provider Details

I. General information

NPI: 1457331878
Provider Name (Legal Business Name): THOMAS W. DAVIS IV PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHARLOIS BLVD DBA WINSTON-SALEM HEALTHCARE
WINSTON SALEM NC
27103-1508
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 200 (ATTN) FORSYTH MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1000
  • Fax: 336-718-1050
Mailing address:
  • Phone: 336-277-2435
  • Fax: 336-277-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: