MEDICARE: ANGELA DAVIS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295311975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DAVIS

Provider Business Mailing Address
First Line	:	1005 SHALLOWFORD DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-7654
Country	:	US
Telephone Number	:	910-547-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 SHALLOWFORD DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-7654
Country	:	US
Telephone Number	:	910-547-1148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	04/22/2022

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Directions to “ ANGELA DAVIS ” Practice Location

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