Provider Demographics
NPI:1952537458
Name:JOHNSON DAVIS, NATHALIE J (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:J
Last Name:JOHNSON DAVIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 POPLAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6005
Mailing Address - Country:US
Mailing Address - Phone:901-758-2228
Mailing Address - Fax:901-531-6735
Practice Address - Street 1:7901 POPLAR AVENUE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6005
Practice Address - Country:US
Practice Address - Phone:901-758-2228
Practice Address - Fax:901-531-6735
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA000001051231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist