Provider Demographics
NPI:1245790138
Name:DAVIS, BENJAMIN BRACEY (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BRACEY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1112 E WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2647
Mailing Address - Country:US
Mailing Address - Phone:865-558-9862
Mailing Address - Fax:865-584-3478
Practice Address - Street 1:1112 E WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2647
Practice Address - Country:US
Practice Address - Phone:865-558-9862
Practice Address - Fax:865-584-3478
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-006282085R0202X
TN4288382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology