Healthcare Provider Details

I. General information

NPI: 1215219530
Provider Name (Legal Business Name): VIRGINIA L DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 FARM ROAD 3019 FM 3019
WINNSBORO TX
75494-4859
US

IV. Provider business mailing address

798 FARM ROAD 3019 FM 3019
WINNSBORO TX
75494-4859
US

V. Phone/Fax

Practice location:
  • Phone: 903-885-3173
  • Fax: 903-885-5544
Mailing address:
  • Phone: 903-885-3173
  • Fax: 903-885-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberM9859
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number60702
License Number StateTX

VIII. Authorized Official

Name: VIRGINIA L DAVIS
Title or Position: MANAGER
Credential: M.S.
Phone: 903-885-3173