Provider Demographics
NPI:1730542663
Name:DAVIS, BETHANY (MD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 MADISON ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8033
Mailing Address - Country:US
Mailing Address - Phone:931-614-7169
Mailing Address - Fax:877-958-9018
Practice Address - Street 1:1947 MADISON ST STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8033
Practice Address - Country:US
Practice Address - Phone:931-614-7169
Practice Address - Fax:877-958-9018
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30249207Q00000X
NE30246207Q00000X
390200000X
TN66265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program