MEDICARE: HANNAH GRACE 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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1659848257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH GRACE DAVIS

Provider Business Mailing Address
First Line	:	3612 MELDA DR
Second Line	:
City	:	LAUDERDALE
State	:	MS
Zip	:	39335-9411
Country	:	US
Telephone Number	:	601-917-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 MELDA DR
Second Line	:
City	:	LAUDERDALE
State	:	MS
Zip	:	39335-9411
Country	:	US
Telephone Number	:	601-917-3335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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Directions to “ HANNAH GRACE DAVIS ” Practice Location

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