Healthcare Provider Details

I. General information

NPI: 1396476750
Provider Name (Legal Business Name): RAFI DAOU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SKYLINE DR
JACKSON TN
38301-3923
US

IV. Provider business mailing address

100 CORINTHIAN CV APT F102
JACKSON TN
38305-3264
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT227159
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number74468
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: