Provider Demographics
NPI:1639867807
Name:DAVIS, JOHN BRYON (CPSS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRYON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-6709
Mailing Address - Country:US
Mailing Address - Phone:704-284-2909
Mailing Address - Fax:
Practice Address - Street 1:5601 EXECUTIVE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8841
Practice Address - Country:US
Practice Address - Phone:704-537-1022
Practice Address - Fax:704-569-0822
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021849801175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist