Provider Demographics
NPI:1346242203
Name:DAVIS, EDWARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 WEST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3884
Mailing Address - Country:US
Mailing Address - Phone:901-421-5174
Mailing Address - Fax:
Practice Address - Street 1:2189 WEST ST STE 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3884
Practice Address - Country:US
Practice Address - Phone:901-421-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17187207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3068771Medicaid
TNQ003684Medicaid
TN3068775Medicare PIN
TN930119614Medicare PIN
TNA98382Medicare UPIN