Individual
DANIELLE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 KIMBROUGH BLVD BLDG Q124, TALLULAH, LA 71282-4307
(601) 574-4400
Mailing address
PO BOX 53, SONDHEIMER, LA 71276-0053
(318) 418-3192
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
12/23/2019
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