Provider Demographics
NPI:1922070481
Name:DAVISS, WILLIAM BURLESON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BURLESON
Last Name:DAVISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:BURLESON
Other - Last Name:DAVISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-4724
Mailing Address - Fax:603-650-0819
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-4724
Practice Address - Fax:603-650-0819
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH61542084P0804X
NH94752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE3795Medicaid
NH3084158Medicaid
TX099493103Medicaid
VT0RE3795Medicaid
NH002389901Medicare PIN
TX8G9369Medicare PIN