Provider Demographics
NPI:1154508935
Name:ANDDAV ANALYSIS, INC.
Entity Type:Organization
Organization Name:ANDDAV ANALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-652-0066
Mailing Address - Street 1:9370 WILSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CORMORANT
Mailing Address - State:MS
Mailing Address - Zip Code:38641-9480
Mailing Address - Country:US
Mailing Address - Phone:901-652-0066
Mailing Address - Fax:662-781-2704
Practice Address - Street 1:9370 WILSON MILL RD
Practice Address - Street 2:
Practice Address - City:LAKE CORMORANT
Practice Address - State:MS
Practice Address - Zip Code:38641-9480
Practice Address - Country:US
Practice Address - Phone:901-652-0066
Practice Address - Fax:662-781-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies