Provider Demographics
NPI:1215397054
Name:GUNN DAVIS, BERNICE
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:GUNN DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 MOUNT MORIAH ROAD EXT
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0313
Mailing Address - Country:US
Mailing Address - Phone:901-674-9369
Mailing Address - Fax:
Practice Address - Street 1:6099 MOUNT MORIAH ROAD EXT
Practice Address - Street 2:SUITE 9B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0313
Practice Address - Country:US
Practice Address - Phone:901-674-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-06
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113002328343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)