Individual
MARY J. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
OVERTON BROOKS VA MEDICAL CENTER, 510 E. STONER AVENUE, SHREVEPORT, LA 71101-4295
(318) 221-8411
(318) 429-5721
Mailing address
700 ARLINGTON ST, RUSTON, LA 71270-4952
(318) 255-6017
(318) 429-5721
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
5639
LA
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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