Healthcare Provider Details

I. General information

NPI: 1023155298
Provider Name (Legal Business Name): MRS. GLORI JANET DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 ATKINSON ST
LAURINBURG NC
28352-4723
US

IV. Provider business mailing address

12180 ROSEWOOD ST
LAURINBURG NC
28352-2374
US

V. Phone/Fax

Practice location:
  • Phone: 910-277-2563
  • Fax: 910-277-2564
Mailing address:
  • Phone: 910-277-2563
  • Fax: 910-277-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberHC3328
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHC3328
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberHC3328
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC3328
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC3328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: