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General NPI Number Information
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NPI Number | 1003021858
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Entity Type | Organization
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Legal Business Name | GLENN A DAVIS, MD (RHC)
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 1020 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2453
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Country | US
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Telephone | 931-728-2022
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Fax | 931-723-1210
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Provider Business Mailing Address
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Address Line | 1020 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2453
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Country | US
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Telephone | 931-728-2022
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Fax | 931-723-1210
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Authorized Official
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Title or Position | BILLING
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Name | MS. TRACY A HOWARD
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Credential |
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Telephone | 931-728-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | MD16760
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License Number State | TN
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