Healthcare Provider Details

I. General information

NPI: 1770251274
Provider Name (Legal Business Name): JAMES COLEMAN DAVIS JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LINDA LN
MONTEVALLO AL
35115-5445
US

IV. Provider business mailing address

101 LINDA LN
MONTEVALLO AL
35115-5445
US

V. Phone/Fax

Practice location:
  • Phone: 334-437-0263
  • Fax:
Mailing address:
  • Phone: 334-437-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-176162
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: