Provider Demographics
NPI:1255641015
Name:TONYA S DAVIS
Entity type:Organization
Organization Name:TONYA S DAVIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-441-6000
Mailing Address - Street 1:1904 HIGHWAY 46 S STE 3
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-7745
Mailing Address - Country:US
Mailing Address - Phone:615-441-6000
Mailing Address - Fax:615-375-8469
Practice Address - Street 1:1904 HWY 46 S
Practice Address - Street 2:SUITE 3
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7744
Practice Address - Country:US
Practice Address - Phone:615-441-6000
Practice Address - Fax:615-375-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty