Provider Demographics
NPI:1396304077
Name:DAVIS, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 CROOKED CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-4459
Mailing Address - Country:US
Mailing Address - Phone:601-918-6686
Mailing Address - Fax:601-376-0574
Practice Address - Street 1:9910 CROOKED CREEK CIR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-4459
Practice Address - Country:US
Practice Address - Phone:601-918-6686
Practice Address - Fax:601-376-0574
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800540038343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)