Provider Demographics
NPI:1417767971
Name:DAVIS, ADRIAN SHALONE
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:SHALONE
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 1:1434 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3843
Mailing Address - Country:US
Mailing Address - Phone:601-953-8812
Mailing Address - Fax:
Practice Address - Street 1:1434 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3843
Practice Address - Country:US
Practice Address - Phone:601-953-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver