Healthcare Provider Details

I. General information

NPI: 1922162619
Provider Name (Legal Business Name): JAMIE T DAVIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 TROTWOOD AVE
COLUMBIA TN
38401-6406
US

IV. Provider business mailing address

1670 W MAIN ST STE 140
LEBANON TN
37087-1345
US

V. Phone/Fax

Practice location:
  • Phone: 931-540-4140
  • Fax: 931-540-4143
Mailing address:
  • Phone: 615-453-9492
  • Fax: 615-453-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: