Provider Demographics
NPI:1922000819
Name:DAVIS, LOCKE H (CPO)
Entity Type:Individual
Prefix:MR
First Name:LOCKE
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3023
Mailing Address - Country:US
Mailing Address - Phone:423-622-2000
Mailing Address - Fax:423-622-2400
Practice Address - Street 1:1700 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3023
Practice Address - Country:US
Practice Address - Phone:423-622-2000
Practice Address - Fax:423-622-2400
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPO009401744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4033710OtherBLUECROSS
TN1454227Medicaid
TN5385780001Medicare ID - Type Unspecified