Healthcare Provider Details

I. General information

NPI: 1265890107
Provider Name (Legal Business Name): CAROL DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6532 WALNUT GROVE RD
ALTOONA AL
35952-8405
US

IV. Provider business mailing address

2837 SPRINGVILLE BLVD
ONEONTA AL
35121-7054
US

V. Phone/Fax

Practice location:
  • Phone: 205-589-6394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-096268
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: