Healthcare Provider Details

I. General information

NPI: 1780791897
Provider Name (Legal Business Name): ANNA F DAVIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 KIRBY WHITTEN RD #104
BARTLETT TN
38134-2881
US

IV. Provider business mailing address

3173 KIRBY WHITTEN RD STE 104
BARTLETT TN
38134-2881
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-3697
  • Fax: 901-302-9240
Mailing address:
  • Phone: 901-384-8040
  • Fax: 901-309-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1224
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number01224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: