Basic Information
| Provider Information | |||||||||
| NPI: | 1316176050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS E. DAVIS, MD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4295 CROMWELL RD | ||||||||
| Address2: | STE. 308 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238772312 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2412 MCCALLIE AVE | ||||||||
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| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236980221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 08/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4238274393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 36302 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.