Individual
MRS. DALLAS JORDAN DAVIS PROVENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6254 POPLAR AVE, MEMPHIS, TN 38119-4713
(901) 624-3333
Mailing address
295 PANDORA ST, MEMPHIS, TN 38117-2854
(901) 338-1340
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
28973
TN
Other
Enumeration date
04/02/2021
Last updated
04/02/2021
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