Individual
DAVIN RAY MODISETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23 WESTHAVEN PL, JACKSON, TN 38305-1758
(318) 475-0690
(731) 435-3385
Mailing address
23 WESTHAVEN PL, JACKSON, TN 38305-1758
(318) 475-0690
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
487010
TN
Other
Enumeration date
06/04/2015
Last updated
12/28/2022
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