MEDICARE: ANNA F. DAVIS, PHD

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1407017585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNA F. DAVIS, PHD

Provider Business Mailing Address
First Line	:	3958 N GALLOWAY DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 POPLAR AVE STE 316
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4806
Country	:	US
Telephone Number	:	901-682-6828
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	ANNA F. DAVIS
Credential	:	PHD
Telephone Number	:	901-682-6828

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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