Provider Demographics
NPI:1386203834
Name:DAVIS, GRIFFITH TANNER (PA-C)
Entity Type:Individual
Prefix:
First Name:GRIFFITH
Middle Name:TANNER
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 1:468 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1631
Mailing Address - Country:US
Mailing Address - Phone:559-591-6200
Mailing Address - Fax:
Practice Address - Street 1:468 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1631
Practice Address - Country:US
Practice Address - Phone:559-591-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant