Provider Demographics
NPI:1326780487
Name:DAVIS, JANSON DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:JANSON
Middle Name:DAVID
Last Name:DAVIS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9785 HIGHWAY 79 S # NA
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:TN
Mailing Address - Zip Code:38231-3613
Mailing Address - Country:US
Mailing Address - Phone:731-243-1450
Mailing Address - Fax:731-243-1000
Practice Address - Street 1:9785 HIGHWAY 79 S # NA
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:TN
Practice Address - Zip Code:38231-3613
Practice Address - Country:US
Practice Address - Phone:731-243-1450
Practice Address - Fax:731-243-1000
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical