Provider Demographics
NPI:1326780487
Name:DAVIS, JANSON DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:JANSON
Middle Name:DAVID
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 HICO RD
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-8717
Mailing Address - Country:US
Mailing Address - Phone:731-693-9306
Mailing Address - Fax:
Practice Address - Street 1:1894 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2206
Practice Address - Country:US
Practice Address - Phone:731-207-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant