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General NPI Number Information
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NPI Number | 1245575885
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Entity Type | Individual
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Provider Name | GRANT H DAVIS ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 12/09/2012
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 502 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-5907
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Country | US
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Telephone | 865-981-8289
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Fax |
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Provider Business Mailing Address
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Address Line | 7413 WERKBUND WAY
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City | KNOXVILLE
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State | TN
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Zip | 37920-7631
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Country | US
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Telephone | 865-806-1491
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1318
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License Number State | TN
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