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Individual

R GLENN DAVIS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7000
Mailing address
238 LAKE MEADOW DR, JOHNSON CITY, TN 37615-4015

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN35683
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3602775
TN
Enumeration date
05/10/2006
Last updated
07/08/2007
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