Provider Demographics
NPI:1417984006
Name:DAVIS, CHAD JOSEPH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:JOSEPH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8905
Mailing Address - Country:US
Mailing Address - Phone:601-606-9433
Mailing Address - Fax:
Practice Address - Street 1:2749 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8904
Practice Address - Country:US
Practice Address - Phone:601-606-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer