Provider Demographics
NPI:1154386035
Name:DAVIS, WILLIAM GERALD (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GERALD
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 1:107 IMPERIAL BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3479
Mailing Address - Country:US
Mailing Address - Phone:615-824-9653
Mailing Address - Fax:615-824-9663
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-824-9653
Practice Address - Fax:615-824-9663
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15629208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3008124Medicaid
TN30081241Medicare ID - Type Unspecified
TNA97259Medicare UPIN