Provider Demographics
NPI:1588776637
Name:DAVIS, JR, LONNIE RAY (MSS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:RAY
Last Name:DAVIS, JR
Suffix:
Gender:M
Credentials:MSS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:740 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3823
Mailing Address - Country:US
Mailing Address - Phone:919-928-9099
Mailing Address - Fax:
Practice Address - Street 1:4600 W LAKE RD
Practice Address - Street 2:WEST LAKE MIDDLE SCHOOL
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-7657
Practice Address - Country:US
Practice Address - Phone:919-662-2918
Practice Address - Fax:919-662-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer