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General NPI Number Information
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NPI Number | 1811099708
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Entity Type | Individual
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Provider Name | JOHN JUNIOUS DAVIS PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 3461 AUSTIN PEAY HWY
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City | MEMPHIS
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State | TN
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Zip | 38128-3801
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Country | US
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Telephone | 901-261-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 8738 SOUTHWIND DR
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City | MEMPHIS
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State | TN
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Zip | 38125-0751
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Country | US
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Telephone | 901-482-3061
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Fax | 901-377-5200
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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 |
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License Number State |
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