Basic Information
| Provider Information | |||||||||
| NPI: | 1013135623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2412 MCCALLIE AVE | ||||||||
| Address2: | HEALTHSOUTH CHATTANOOGA REHAB. HOSP. | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236980221 | ||||||||
| FaxNumber: | 4236979628 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 MCCALLIE AVE | ||||||||
| Address2: | HEALTHSOUTH CHATTANOOGA REHAB. HOSP. | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236980221 | ||||||||
| FaxNumber: | 4236979628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2007 | ||||||||
| LastUpdateDate: | 12/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 36302 | TN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.