Healthcare Provider Details

I. General information

NPI: 1740856186
Provider Name (Legal Business Name): RACHEL DIANE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

107 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-2800
  • Fax: 931-722-9627
Mailing address:
  • Phone: 931-722-2800
  • Fax: 931-722-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29446
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: