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NPI Code Detail

MEDICARE: MR. VINCENT EDWARD DAVIDSONS B.S.

MEDICARE: MR. VINCENT EDWARD DAVIDSONS B.S.
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1154459220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VINCENT EDWARD DAVIDSONS B.S.
Provider Business Mailing Address
First Line : 317 COTTONWOOD CT
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-8553
Country : US
Telephone Number : 931-920-7200
Fax Number : 931-920-7202
Provider Business Practice Location Address
First Line : 511 8TH ST
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-3093
Country : US
Telephone Number : 931-920-7200
Fax Number : 931-920-7202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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