Basic Information
| Provider Information | |||||||||
| NPI: | 1447405998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ANDERSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 965 RIDGE LAKE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381209446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012273255 | ||||||||
| FaxNumber: | 9012278591 | ||||||||
| Practice Location | |||||||||
| Address1: | 7275 S SIWELL RD | ||||||||
| Address2: | |||||||||
| City: | BYRAM | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392729776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013737722 | ||||||||
| FaxNumber: | 6013737378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20489 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.