Provider Demographics
NPI:1609662261
Name:DAVIS, TAWANNA DENISE (MD10275301878)
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:
Credentials:MD10275301878
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 23RD PKWY APT 207
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4449
Mailing Address - Country:US
Mailing Address - Phone:301-257-9958
Mailing Address - Fax:
Practice Address - Street 1:4339 BOWEN RD SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5632
Practice Address - Country:US
Practice Address - Phone:301-257-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant