Healthcare Provider Details

I. General information

NPI: 1508806308
Provider Name (Legal Business Name): SUEANNE DAVIDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN MORDECAI DAVIDSON

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 5TH ST NE
ALICEVILLE AL
35442-2200
US

IV. Provider business mailing address

PO BOX 211
CARROLLTON AL
35447-0211
US

V. Phone/Fax

Practice location:
  • Phone: 205-373-3945
  • Fax:
Mailing address:
  • Phone: 205-399-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-06250
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR865907
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: