Provider Demographics
NPI:1619213246
Name:DAVIS, ADRIAN MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:MICHELLE
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 1:1643 PRINGLE CIR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4376
Mailing Address - Country:US
Mailing Address - Phone:228-313-8968
Mailing Address - Fax:
Practice Address - Street 1:1643 PRINGLE CIR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4376
Practice Address - Country:US
Practice Address - Phone:228-313-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver