Provider Demographics
NPI:1285201442
Name:DAVIS, ANTHONY D (TARGETED CASE MANAGE)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:TARGETED CASE MANAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 BLUE LICK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-1843
Mailing Address - Country:US
Mailing Address - Phone:502-822-9936
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 226
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:KY
Practice Address - Zip Code:40207-4847
Practice Address - Country:US
Practice Address - Phone:502-896-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator