Provider Demographics
NPI:1639645989
Name:DAVIS, TAMEKA
Entity Type:Individual
Prefix:
First Name:TAMEKA
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:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:MS
Mailing Address - Zip Code:39743-0482
Mailing Address - Country:US
Mailing Address - Phone:662-346-6574
Mailing Address - Fax:662-272-9522
Practice Address - Street 1:79 SHORT ST
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:MS
Practice Address - Zip Code:39743
Practice Address - Country:US
Practice Address - Phone:662-346-6574
Practice Address - Fax:662-272-9522
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800822870343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)