Provider Demographics
NPI:1578824934
Name:DAVIS NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:DAVIS NEUROLOGY, PLLC
Other - Org Name:DAVIS NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-880-0101
Mailing Address - Street 1:220 N PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2826
Mailing Address - Country:US
Mailing Address - Phone:479-880-0101
Mailing Address - Fax:479-880-0118
Practice Address - Street 1:220 N PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2826
Practice Address - Country:US
Practice Address - Phone:479-880-0101
Practice Address - Fax:479-880-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty