Basic Information
| Provider Information | |||||||||
| NPI: | 1962058867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | CHASE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 DOUBLE EAGLE DR | ||||||||
| Address2: | |||||||||
| City: | SUMMERTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384837289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316291518 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2019 N LOCUST AVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384642337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317621800 | ||||||||
| FaxNumber: | 9317629155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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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 | 363L00000X | 26381 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.