Provider Demographics
NPI:1801838859
Name:DAVIS, DENNIS ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ALLAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-5321
Mailing Address - Fax:731-588-3229
Practice Address - Street 1:143 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3309
Practice Address - Country:US
Practice Address - Phone:731-587-5321
Practice Address - Fax:731-588-3229
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28963174400000X
TN46558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4277903OtherBCBS
TN1522027Medicaid
GA010015387OtherRAILROAD MEDICARE
GA237034DAOtherBC/BS
GA00328391AMedicaid
GA237034DAOtherBC/BS
TN103I022683Medicare PIN