Timothy Wayne Davis, LCSW
Individual provider Active NPI Clinical Social Worker · Jefferson City, TN
NPI 1104896745 · NPPES record last updated May 19, 2009
Key facts
- NPI
- 1104896745
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4142 (TN)
- Practice address
- 283 W Broadway Blvd
Jefferson City, TN 37760-2302 - Phone
- (865) 475-8037
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060220000418 | TN | Practitioner - Clinical Social Worker | 4284649716 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paradigm Health Services, Inc | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4142 | TN | Yes |
Addresses
Primary practice location
283 W Broadway Blvd
Jefferson City, TN 37760-2302
Mailing address
5310 Ward Road
Suite 106
Arvada, CO 80002-1829
Phone (877) 838-4783
Other providers in Jefferson City, TN
- Eden A Daniel
- Shawn Daniel
- Morgan Ella Daniels
- Darby House, LLC
- Bruce Davenport
- Amber Nicole Day
- Jeremy Len Diamond
- James David Dolbow
- Dr. William B Harris Gynecology, PC
- Candice Durman
All providers in Jefferson City, TN · Clinical Social Worker in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.