Provider Demographics
NPI:1265570543
Name:DAVIS, MARTHA JANE (BSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:101 LENA DRIVE
Practice Address - Street 2:HAWKINS COUNTY MENTAL HEALTH CLINIC
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857
Practice Address - Country:US
Practice Address - Phone:423-502-9158
Practice Address - Fax:423-272-1803
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator