Healthcare Provider Details

I. General information

NPI: 1003977802
Provider Name (Legal Business Name): LAURIA JANEE DAVIS R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

112 AMACORD WAY
HOLLY SPRINGS NC
27540-9630
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-8741
  • Fax:
Mailing address:
  • Phone: 919-762-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: