Active NPI
Clay Deneeen Davis, PA
- Physician Assistant
- Kingsport, TN
National Provider Identifier
1477751238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1333
- Practice address
- 4509 W Stone Dr
Kingsport, TN 37660-1048 - Phone
- (423) 578-6484
- NPI assigned
- Jul 3, 2007
- Last updated
- Apr 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1333 | TN | Primary |
Addresses
Primary practice location
4509 W Stone Dr
Kingsport, TN 37660-1048
Mailing address
4509 W Stone Dr
Kingsport, TN 37660-1048
Phone (423) 578-6484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1333 | TN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MH Health Care Services, PC | Past | Accepting new patients | |
| Emergency Care Physicians, Inc. | Past | Accepting new patients |
Interoperability endpoints
- clay.davis.1@14940.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Johnson City, TN
- NPI 1669410304
-
- Non-Pharmacy Dispensing Site
- Colchester, VT
- NPI 1316260631
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397433600000",
"number": "1477751238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4509 W STONE DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376601048",
"telephone_number": "423-578-6484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4509 W STONE DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376601048",
"telephone_number": "423-578-6484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CLAY",
"middle_name": "DENEEEN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-03",
"last_updated": "2014-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "1333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.