Provider Demographics
NPI:1598156911
Name:DAVIS, TAR
Entity Type:Individual
Prefix:
First Name:TAR
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3282
Mailing Address - Country:US
Mailing Address - Phone:336-803-4001
Mailing Address - Fax:336-803-4034
Practice Address - Street 1:10418 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3282
Practice Address - Country:US
Practice Address - Phone:336-803-4001
Practice Address - Fax:336-803-4034
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4717374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide