Provider Demographics
NPI:1497445449
Name:DAVIS, JOHNATHON DEWAYNE (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHON
Middle Name:DEWAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HERITAGE DR APT 288
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-6025
Mailing Address - Country:US
Mailing Address - Phone:615-762-0529
Mailing Address - Fax:
Practice Address - Street 1:1001 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5721
Practice Address - Country:US
Practice Address - Phone:615-762-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14005171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor