Provider Demographics
NPI:1285179077
Name:DAVIS, BILL LEE TODD
Entity Type:Individual
Prefix:MR
First Name:BILL LEE
Middle Name:TODD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 MURRILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8662
Mailing Address - Country:US
Mailing Address - Phone:910-545-2459
Mailing Address - Fax:
Practice Address - Street 1:1151 MURRILL HILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8662
Practice Address - Country:US
Practice Address - Phone:910-545-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman