Individual
COREY LAMONN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 4793
MS
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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