Individual
TAMMY JILL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF FAMILY MEDICINE, SHREVEPORT, LA 71103-4228
(318) 675-8032
(318) 675-8775
Mailing address
1501 KINGS HWY, DEPARTMENT OF FAMILY MEDICINE, SHREVEPORT, LA 71103-4228
(318) 675-8032
(318) 675-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07634R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386596
—
LA
Enumeration date
07/09/2006
Last updated
12/03/2018
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