IndividualActive
Davin Modisette
NPI 1356721245 · Radiologic Technologist · Jackson, TN
Provider details
- NPI number
- 1356721245
- Entity type
- Individual
- Primary specialty
- Radiologic TechnologistTechnologists, Technicians & Other Technical Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 487010 (TN)
Specialties & taxonomies
Technologists, Technicians & Other Technical Service Providers
Practice location
23 Westhaven Pl
Jackson, TN 38305-1758
Phone: (318) 475-0690
Fax: (731) 435-3385
Approximate (ZIP-level) locationGet directions
Mailing address
23 Westhaven Pl
Jackson, TN 38305-1758
Registry dates
- Enumerated
- 2015-06-04
- Last updated
- 2022-12-28
- Certified
- 2022-12-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.