Provider Demographics
NPI:1265652580
Name:DAVIS, FANNIE MARIE (BS)
Entity Type:Individual
Prefix:MISS
First Name:FANNIE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 FERN DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6617
Mailing Address - Country:US
Mailing Address - Phone:214-849-3597
Mailing Address - Fax:214-857-1281
Practice Address - Street 1:623 FERN DRIVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6617
Practice Address - Country:US
Practice Address - Phone:214-849-3597
Practice Address - Fax:214-857-1281
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist