Provider Demographics
NPI:1780838979
Name:DAVIS, ROSE MARIE (BS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LENA DR
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-2951
Mailing Address - Country:US
Mailing Address - Phone:423-272-9239
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:101 LENA DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2951
Practice Address - Country:US
Practice Address - Phone:423-467-3721
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator