Healthcare Provider Details

I. General information

NPI: 1376527374
Provider Name (Legal Business Name): MARY S DAVID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARR AVE
DYERSBURG TN
38024-2004
US

IV. Provider business mailing address

1755 PARR AVE
DYERSBURG TN
38024-2004
US

V. Phone/Fax

Practice location:
  • Phone: 731-285-7311
  • Fax: 731-285-2610
Mailing address:
  • Phone: 731-285-7311
  • Fax: 731-285-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD0000012141
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: