Janson David Davis, PA-C
Individual provider Active NPI Physician Assistant · Henry, TN
NPI 1326780487 · NPPES record last updated Apr 22, 2025
Key facts
- NPI
- 1326780487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 9785 Highway 79 S # NA
Henry, TN 38231-3613 - Phone
- (731) 243-1450
- Fax
- (731) 243-1000
- NPI assigned
- Apr 10, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Waddell Clinic Primary Care and Aesthetics PLLC
Practice addresses (Care Compare)
9785 Hwy 79S
Henry, TN 38231
Phone (731) 415-8277
Hospital & facility affiliations
- Baptist Memorial Home Care
- Baptist Memorial Hospital - Carroll County
- West Tennessee Healthcare Henry County Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221012004175 | TN | Practitioner - Physician Assistant | 1052787264 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5072 | TN | MD | General Practice Dentistry |
Interoperability endpoints
- janson.davis.1@30275.direct.athenahealth.com
- jdavis539722@direct.bmhcc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | |||
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
9785 Highway 79 S # NA
Henry, TN 38231-3613
Mailing address
9785 Highway 79 S # NA
Henry, TN 38231-3613
Phone (731) 243-1450
Other providers in Henry, TN
- Markie Brooke Anderson
- Casey Crosser
- Waddell Clinic Primary Care & Aesthetics PLLC
- Donna Jane Waddell
All providers in Henry, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2025. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.