Provider Demographics
NPI:1194404459
Name:DAVIS UNLIMITED HEALTHCARE SERVICES, PLLC
Entity type:Organization
Organization Name:DAVIS UNLIMITED HEALTHCARE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGH-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:662-545-2421
Mailing Address - Street 1:1148 OLD HIGHWAY 61 STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-9735
Mailing Address - Country:US
Mailing Address - Phone:662-545-2421
Mailing Address - Fax:662-200-5908
Practice Address - Street 1:1148 OLD HIGHWAY 61 STE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-9735
Practice Address - Country:US
Practice Address - Phone:662-545-2421
Practice Address - Fax:662-200-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care