Active NPI
Willie Davis Jr., RKT
- Developmentally Disabled Services Day Training Agency
- Hattiesbiurg, MS
National Provider Identifier
1558778936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- License
- 1907
- Practice address
- 701 Duke Ave.
Hattiesbiurg, MS 39401 - Phone
- (601) 550-1164
- NPI assigned
- Jul 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | 1907 | IL | Primary |
Addresses
Primary practice location
701 Duke Ave.
Hattiesbiurg, MS 39401
Mailing address
701 Duke Ave
Hattiesburg, MS 39401-4060
Phone (601) 550-1164
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1907 | Other | IL | AMERICAN KINESIOTHERAPY ASSOCIATION |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1907 | IL | MD | Developmentally Disabled Services Day Training Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405555200000",
"number": "1558778936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 DUKE AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394014060",
"telephone_number": "601-550-1164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 DUKE AVE.",
"city": "HATTIESBIURG",
"state": "MS",
"postal_code": "39401",
"telephone_number": "601-550-1164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "WILLIE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RKT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-17",
"last_updated": "2014-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "IL",
"license": "1907",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN KINESIOTHERAPY ASSOCIATION",
"identifier": "1907",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.