Healthcare Provider Details

I. General information

NPI: 1053352641
Provider Name (Legal Business Name): DIANA L DAVIDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BIG COVE ROAD PICU
HUNTSVILLE AL
35801-3738
US

IV. Provider business mailing address

PO BOX 2705
HUNTSVILLE AL
35804-2705
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-7791
  • Fax: 256-265-7767
Mailing address:
  • Phone: 256-519-8362
  • Fax: 256-519-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00012169
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number12169
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: