MEDICARE: DAVIS TREATMENT PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1114233418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS TREATMENT PROGRAM

Provider Business Mailing Address
First Line	:	1113 AIR BASE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36108-3103
Country	:	US
Telephone Number	:	334-425-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1113 AIR BASE BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36108-3103
Country	:	US
Telephone Number	:	334-425-0968
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TIM NAUGHER
Credential	:
Telephone Number	:	256-546-6324

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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