Provider Demographics
NPI:1740550284
Name:DAVIDSON, BARRY DEE (CP 3147,)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DEE
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CP 3147,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3993
Mailing Address - Country:US
Mailing Address - Phone:931-267-7703
Mailing Address - Fax:
Practice Address - Street 1:735 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3993
Practice Address - Country:US
Practice Address - Phone:931-267-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN06222Z00000X
TN07224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist