Provider Demographics
NPI:1285133769
Name:DAVIDS, JOHN FORD SR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FORD
Last Name:DAVIDS
Suffix:SR
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 1:174 TWIN TUNNEL LN
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-9831
Mailing Address - Country:US
Mailing Address - Phone:434-664-8867
Mailing Address - Fax:
Practice Address - Street 1:174 TWIN TUNNEL LN
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-9831
Practice Address - Country:US
Practice Address - Phone:434-664-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty