Provider Demographics
NPI:1295842169
Name:CLEVELAND, DAVA SUE (DO)
Entity Type:Individual
Prefix:
First Name:DAVA
Middle Name:SUE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9019
Mailing Address - Country:US
Mailing Address - Phone:601-815-5700
Mailing Address - Fax:601-815-5795
Practice Address - Street 1:2466 FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9019
Practice Address - Country:US
Practice Address - Phone:601-815-5700
Practice Address - Fax:601-815-5795
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1232207ZC0006X
MST-4508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology