Provider Demographics
NPI:1427217744
Name:DAVIS, CLARENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:
Last Name:DAVIS
Suffix:JR
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 1:787 HARBOR BEND RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-0818
Mailing Address - Country:US
Mailing Address - Phone:901-482-2606
Mailing Address - Fax:
Practice Address - Street 1:360 E EH CRUMP BLVD
Practice Address - Street 2:UITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5310
Practice Address - Country:US
Practice Address - Phone:901-261-2000
Practice Address - Fax:901-946-9262
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0020959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine