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NPI Code Detail

MEDICARE: TANYA L DAVIS

MEDICARE: TANYA L DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)18972-08-014VA

General Provider Information

NPI Number : 1063348142
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA L DAVIS
Provider Business Mailing Address
First Line : 4860 COX RD STE 200
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9248
Country : US
Telephone Number : 317-222-9888
Fax Number : 317-823-2853
Provider Business Practice Location Address
First Line : 4860 COX RD STE 200
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9248
Country : US
Telephone Number : 317-222-9888
Fax Number : 317-823-2853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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