Provider Demographics
NPI:1295561678
Name:DAVIS, ANTONIO SPENCER
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:SPENCER
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 1:10915 MOUNT OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-2527
Mailing Address - Country:US
Mailing Address - Phone:216-309-8786
Mailing Address - Fax:
Practice Address - Street 1:10915 MOUNT OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-2527
Practice Address - Country:US
Practice Address - Phone:216-309-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion