Provider Demographics
NPI:1780791897
Name:DAVIS, ANNA F (PHD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 KIRBY WHITTEN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2881
Mailing Address - Country:US
Mailing Address - Phone:901-384-8040
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:3173 KIRBY WHITTEN RD
Practice Address - Street 2:#104
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2881
Practice Address - Country:US
Practice Address - Phone:901-685-3697
Practice Address - Fax:901-302-9240
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1224103TC0700X
TN01224103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017419Medicaid
S05293Medicare UPIN
3982156Medicare ID - Type Unspecified