Basic Information
| Provider Information | |||||||||
| NPI: | 1811370471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM S, DAVIES, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 N, W, LAKE AVE, | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73507 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1302 N, W, LAKE AVE, | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803572304 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | DAVIES | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5803572304 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 8641 | OK | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.