Provider Demographics
NPI:1114402161
Name:DAVIS, JOHN A (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 PEAVINE RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-7903
Mailing Address - Country:US
Mailing Address - Phone:931-250-5900
Mailing Address - Fax:
Practice Address - Street 1:4120 PEAVINE RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38571-7903
Practice Address - Country:US
Practice Address - Phone:931-250-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN660237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist