Active NPI
Brian W Davis, LCSW
- Clinical Social Worker
- Conway, AR
National Provider Identifier
1750338067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1930C
- Practice address
- 350 Salem Rd Ste 1
Conway, AR 72034-6166 - Phone
- (501) 336-8300
- Fax
- (479) 890-5364
- NPI assigned
- May 30, 2006
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1930C | AL | Primary |
Addresses
Primary practice location
350 Salem Rd Ste 1
Conway, AR 72034-6166
Mailing address
110 Skyline Drive
Russellville, AR 72801
Phone (479) 967-5570
Other practice location 1
4040 Memorial Pkwy SW
Huntsville, AL 35802-4364
Phone (256) 705-6380
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51532255 | Other | AL | BCBS |
| 51532854 | Other | AL | FEDERAL BCBS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1930C | AL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozark Guidance Center, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Springdale, AR
- NPI 1659945194
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1750338067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 SKYLINE DRIVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "72801",
"telephone_number": "479-967-5570",
"fax_number": "479-890-5364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 SALEM RD STE 1",
"city": "CONWAY",
"state": "AR",
"postal_code": "720346166",
"telephone_number": "501-336-8300",
"fax_number": "479-890-5364"
}
],
"practiceLocations": [
{
"address_1": "4040 Memorial Pkwy SW",
"address_purpose": "LOCATION",
"city": "Huntsville",
"state": "AL",
"postal_code": "358024364",
"country_code": "US",
"telephone_number": "256-705-6380",
"fax_number": "256-532-4112",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "BRIAN",
"middle_name": "W",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AL",
"license": "1930C",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "51532255",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BCBS",
"identifier": "51532854",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.