Provider Demographics
NPI:1598526782
Name:DAVIS, JOSEPH J (AT,C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 GALLERY ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-2311
Mailing Address - Country:US
Mailing Address - Phone:228-990-7233
Mailing Address - Fax:228-762-1629
Practice Address - Street 1:1304 GALLERY ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-2311
Practice Address - Country:US
Practice Address - Phone:228-990-7233
Practice Address - Fax:228-762-1629
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS083252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer