Provider Demographics
NPI:1942031000
Name:DAVIS, TYRONE
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8298 EASTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6029
Mailing Address - Country:US
Mailing Address - Phone:901-930-6178
Mailing Address - Fax:
Practice Address - Street 1:8298 EASTSHORE DR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6029
Practice Address - Country:US
Practice Address - Phone:901-930-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10991267132472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty