Healthcare Provider Details

I. General information

NPI: 1295328268
Provider Name (Legal Business Name): DAVEY GARDNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 ANGEL LN
GALLIPOLIS FERRY WV
25515-7158
US

IV. Provider business mailing address

441 ANGEL LN
GALLIPOLIS FERRY WV
25515-7158
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-9983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: