DALLAS JORDAN DAVIS PROVENCE

MEMPHIS, TN
NPI1619556230
Former NameDALLAS JORDAN DAVIS
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207ND0900X Dermatology, Dermatopathology
(Licence: TN  28973)
Enumeration Date2021-04-02
Last Update Date2021-04-02
Business Address
Mrs. DALLAS JORDAN DAVIS PROVENCE NP
6254 POPLAR AVE
MEMPHIS, TN 38119-4713
Phone number: 901-624-3333
Mailing Address
Mrs. DALLAS JORDAN DAVIS PROVENCE NP
295 PANDORA ST
MEMPHIS, TN 38117-2854
Phone number: 901-338-1340
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