Provider Demographics
NPI:1750748059
Name:DAVIS, SAMUEL CHRISTIAN
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHRISTIAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CIMARRON CIR
Mailing Address - Street 2:101
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6257
Mailing Address - Country:US
Mailing Address - Phone:301-807-5618
Mailing Address - Fax:
Practice Address - Street 1:1300 CIMARRON CIRLCE
Practice Address - Street 2:101
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6205
Practice Address - Country:US
Practice Address - Phone:301-807-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer