Provider Demographics
NPI:1255026134
Name:DAVIS, CHRISTOPHER ALLEN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5538
Mailing Address - Country:US
Mailing Address - Phone:330-880-7773
Mailing Address - Fax:
Practice Address - Street 1:4440 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-5538
Practice Address - Country:US
Practice Address - Phone:330-880-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant