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General NPI Number Information
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NPI Number | 1790029254
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Entity Type | Individual
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Provider Name | BRANDON MICHAEL DAVIS ATC
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Gender | Male
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 5359 FARMVILLE RD
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City | FARMVILLE
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State | VA
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Zip | 23901-5938
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Country | US
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Telephone | 434-223-6237
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Fax | 434-223-6348
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Provider Business Mailing Address
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Address Line | 5359 FARMVILLE RD
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City | FARMVILLE
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State | VA
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Zip | 23901-5938
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Country | US
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Telephone | 434-223-6237
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Fax | 434-223-6348
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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 | 0126000881
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License Number State | VA
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