Provider Demographics
NPI: | 1487732848 |
---|---|
Name: | DUNBAR-DAVIES, WINNIFRED JENNEH (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | WINNIFRED |
Middle Name: | JENNEH |
Last Name: | DUNBAR-DAVIES |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 80982 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHATTANOOGA |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37414 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-495-4349 |
Mailing Address - Fax: | 423-495-4934 |
Practice Address - Street 1: | 3300 WILCOX BLVD. |
Practice Address - Street 2: | |
Practice Address - City: | CHATTANOOGA |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37411 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-803-9180 |
Practice Address - Fax: | 423-803-9181 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-11-02 |
Last Update Date: | 2017-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 27162 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 5487562 | Other | CIGNA |
TN | TN0101 | Other | UHCRIVERYVALLEY |
TN | 4104835 | Other | BLUE CROSS BLUE SHIELD TN |
TN | 100021923 | Other | PHP |
TN | TN0101 | Other | UHCRIVERYVALLEY |
TN | F94312 | Medicare UPIN |