Individual
MR. JOHNATHON DEWAYNE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1001 HEALTH PARK DR, BRENTWOOD, TN 37027-5721
(615) 762-0529
Mailing address
600 HERITAGE DR APT 288, MADISON, TN 37115-6025
(615) 762-0529
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
14005
TN
Other
Enumeration date
05/12/2023
Last updated
05/12/2023
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