Provider Demographics
NPI:1922282201
Name:DAVIS, WILLIAM JAMES (INDEPENDENT DUTY COR)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY COR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 WESTLAND STATION RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7822
Mailing Address - Country:US
Mailing Address - Phone:904-696-5078
Mailing Address - Fax:
Practice Address - Street 1:204 STONEHALL CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4356
Practice Address - Country:US
Practice Address - Phone:757-262-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman