Provider Demographics
NPI:1306135207
Name:DAVIS, WILLIAM ALLAN (DPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALLAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1313
Mailing Address - Country:US
Mailing Address - Phone:931-473-0788
Mailing Address - Fax:931-506-2442
Practice Address - Street 1:1410 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1313
Practice Address - Country:US
Practice Address - Phone:931-473-0788
Practice Address - Fax:931-506-2442
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-5332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist