Healthcare Provider Details

I. General information

NPI: 1811099708
Provider Name (Legal Business Name): JOHN JUNIOUS DAVIS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 AUSTIN PEAY HWY
MEMPHIS TN
38128-3801
US

IV. Provider business mailing address

8738 SOUTHWIND DR
MEMPHIS TN
38125-0751
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-4500
  • Fax:
Mailing address:
  • Phone: 901-482-3061
  • Fax: 901-377-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: