Individual
MR. WILLIE DAVIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RKT
Contact information
Practice address
701 DUKE AVE., HATTIESBIURG, MS 39401
(601) 550-1164
Mailing address
701 DUKE AVE, HATTIESBURG, MS 39401-4060
(601) 550-1164
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
1907
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1907
AMERICAN KINESIOTHERAPY ASSOCIATION
IL
Enumeration date
07/17/2014
Last updated
07/17/2014
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