Provider Demographics
NPI:1093323172
Name:DAVIS, DANIEL TIMOTHY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TIMOTHY
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 1:1553 BRENTWOOD POINTE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1625
Mailing Address - Country:US
Mailing Address - Phone:615-573-1966
Mailing Address - Fax:
Practice Address - Street 1:1553 BRENTWOOD POINTE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1625
Practice Address - Country:US
Practice Address - Phone:615-573-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN054430973172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver