Provider Demographics
NPI:1467604983
Name:DAVIS, CLIFFORD G
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MOUNT SIDNEY SCHOOL LN
Mailing Address - Street 2:APT. 104
Mailing Address - City:MOUNT SIDNEY
Mailing Address - State:VA
Mailing Address - Zip Code:24467-2523
Mailing Address - Country:US
Mailing Address - Phone:540-292-2447
Mailing Address - Fax:
Practice Address - Street 1:26 MOUNT SIDNEY SCHOOL LN
Practice Address - Street 2:APT. 104
Practice Address - City:MOUNT SIDNEY
Practice Address - State:VA
Practice Address - Zip Code:24467-2523
Practice Address - Country:US
Practice Address - Phone:540-292-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705-089910171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications