Provider Demographics
NPI:1669023008
Name:DAVIS, PHYLLIS ANN
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
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 1:4829 VALLEY BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4478
Mailing Address - Country:US
Mailing Address - Phone:901-326-0972
Mailing Address - Fax:
Practice Address - Street 1:4829 VALLEY BIRCH DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4478
Practice Address - Country:US
Practice Address - Phone:901-326-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider