Healthcare Provider Details

I. General information

NPI: 1760682546
Provider Name (Legal Business Name): KIMBERLY NOELLE DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 ARDREY KELL RD
CHARLOTTE NC
28277-5717
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-5540
  • Fax:
Mailing address:
  • Phone: 704-384-7508
  • Fax: 704-384-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101242202
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2016-00365
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016-00365
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: