Individual
TEDDY HARMON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2204 PAVILION DR STE 300, KINGSPORT, TN 37660-4653
(423) 857-7000
Mailing address
2204 PAVILION DR STE 300, KINGSPORT, TN 37660-4653
(423) 857-7000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN0000017383
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01286073
MEDICARE RR
NC
Enumeration date
06/03/2013
Last updated
07/15/2015
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