Healthcare Provider Details

I. General information

NPI: 1407198179
Provider Name (Legal Business Name): HOLLEY LEONA DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLEY LEONA GREEN MD

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR STE 300
CHATTANOOGA TN
37404-1144
US

IV. Provider business mailing address

12101 WOODCREST EXECUTIVE DR SUITE 210
SAINT LOUIS MO
63141-5047
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-2690
  • Fax: 423-495-2698
Mailing address:
  • Phone: 314-317-0600
  • Fax: 314-317-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57539
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2016021070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: