Provider Demographics
NPI:1659848257
Name:DAVIS, HANNAH GRACE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
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 1:3612 MELDA DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39335-9411
Mailing Address - Country:US
Mailing Address - Phone:601-917-3335
Mailing Address - Fax:
Practice Address - Street 1:3612 MELDA DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE
Practice Address - State:MS
Practice Address - Zip Code:39335-9411
Practice Address - Country:US
Practice Address - Phone:601-917-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer