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General NPI Number Information
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NPI Number | 1841628427
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Entity Type | Organization
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Legal Business Name | DAVIS CLINIC MANAGEMENT INC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 21 SCHOOL ST SUITE 1
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City | QUINCY
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State | MA
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Zip | 02169-6640
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Country | US
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Telephone | 860-839-4508
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SCHOOL ST SUITE 1
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City | QUINCY
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State | MA
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Zip | 02169-6640
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Country | US
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Telephone | 860-839-4508
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID TKHILAISHVILI
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Credential |
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Telephone | 860-839-4508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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