MEDICARE: DAVIS WELLNESS LTD LLP

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1114304805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS WELLNESS LTD LLP

Provider Business Mailing Address
First Line	:	3750 S. UNIVERSITY DR.
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3701
Country	:	US
Telephone Number	:	682-312-7919
Fax Number	:	817-920-1855

Provider Business Practice Location Address
First Line	:	3750 S. UNIVERSITY DR.
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3701
Country	:	US
Telephone Number	:	682-312-7919
Fax Number	:	817-920-1855

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	NORMAN JOEL MCCALL
Credential	:	M.D., PHD
Telephone Number	:	682-312-7919

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	09/18/2015

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