Provider Demographics
NPI:1003056789
Name:DAVIS, HARRY
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1651
Mailing Address - Country:US
Mailing Address - Phone:252-285-5098
Mailing Address - Fax:561-688-8877
Practice Address - Street 1:25 E WASHINGTON ST STE 1817
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1807
Practice Address - Country:US
Practice Address - Phone:636-397-6966
Practice Address - Fax:636-397-6836
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO237700000X
NC1542237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist