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General NPI Number Information
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NPI Number | 1205937836
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Entity Type | Individual
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Provider Name | LAURIE E DAVIS MPAS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1400 HATCHER LN
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City | COLUMBIA
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State | TN
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Zip | 38401-3563
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Country | US
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Telephone | 615-410-4990
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Fax | 615-410-4250
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Provider Business Mailing Address
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Address Line | 2548 RIDEOUT LN
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City | MURFREESBORO
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State | TN
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Zip | 37128-7686
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Country | US
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Telephone | 615-410-4990
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Fax | 615-410-4250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1886
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License Number State | TN
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