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General NPI Number Information
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NPI Number | 1063461515
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Entity Type | Individual
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Provider Name | MARCUS B. DAVIS LPA
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 284 EXECUTIVE PARK DR SUITE 100
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City | CONCORD
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State | NC
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Zip | 28025-1831
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Country | US
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Telephone | 704-939-1100
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Fax | 704-939-1173
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Provider Business Mailing Address
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Address Line | 1400 WILLOW LN
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-3551
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Country | US
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Telephone | 336-667-5151
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Fax | 336-838-3133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2585
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License Number State | NC
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