Davin Ray Modisette

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

License

487010 Issued in TN

Practice address

23 Westhaven PL
Jackson, TN 38305-1758

Phone

(318) 475-0690

Fax

(731) 435-3385

NPI assigned

Jun 4, 2015

Last updated

Dec 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr Mobile Imaging, LLC

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Jackson, TN
  • NPI 1851949291
  NPD
• D.R. Mobile Imaging, LLC

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Calhoun, LA
  • NPI 1023492832
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1356721245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 WESTHAVEN PL",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051758",
            "telephone_number": "318-475-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 WESTHAVEN PL",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051758",
            "telephone_number": "318-475-0690",
            "fax_number": "731-435-3385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODISETTE",
        "first_name": "DAVIN",
        "middle_name": "RAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "TN",
            "license": "487010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Wesley Mitchell, M.D.
• Freddie Laredia Mitchell
• Gregory Erwin Mitchell, MD
• William Clay Mitchell III, M.D.
• Julia Lynn Mobiglia
• Harmony Anne Moellman Sprinkle, PTA
• Mohamad R Karami-Sichani (Advanced Psychiatric Services)
• Mohamad R Karami-Sichani (Advanced Psychiatric Services)
• Mohamad R Karami-Sichani (Advanced Psychiatric Services)
• Emad Hashim Mohamed, M.D.

• Radiologic Technologist in Jackson, TN
• Providers in Jackson, TN by specialty
• Radiologic Technologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.