Provider Demographics
NPI:1891832101
Name:DAVIS, GREG (BS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1489
Mailing Address - Country:US
Mailing Address - Phone:931-526-8635
Mailing Address - Fax:
Practice Address - Street 1:1420 NEAL ST
Practice Address - Street 2:SUITEB 202
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4333
Practice Address - Country:US
Practice Address - Phone:931-525-6900
Practice Address - Fax:931-525-6970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health