Healthcare Provider Details

I. General information

NPI: 1114233418
Provider Name (Legal Business Name): DAVIS TREATMENT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 AIR BASE BLVD
MONTGOMERY AL
36108-3103
US

IV. Provider business mailing address

1113 AIR BASE BLVD
MONTGOMERY AL
36108-3103
US

V. Phone/Fax

Practice location:
  • Phone: 334-425-0968
  • Fax:
Mailing address:
  • Phone: 334-425-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM NAUGHER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-546-6324