Provider Demographics
NPI:1154546166
Name:DAVIS, ANTHONY C (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 N PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2826
Mailing Address - Country:US
Mailing Address - Phone:479-880-0101
Mailing Address - Fax:479-880-0118
Practice Address - Street 1:220 N PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2826
Practice Address - Country:US
Practice Address - Phone:479-880-0101
Practice Address - Fax:479-880-0118
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-59892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology