Healthcare Provider Details

I. General information

NPI: 1528202389
Provider Name (Legal Business Name): DAVIS SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLLEGE ST SUITE B
ATHENS AL
35611-2714
US

IV. Provider business mailing address

PO BOX 7756
ROCKY MOUNT NC
27804-0756
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-2393
  • Fax:
Mailing address:
  • Phone: 252-985-1371
  • Fax: 252-467-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD L DAVIS
Title or Position: OWNER
Credential: OD
Phone: 256-233-2393