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General NPI Number Information
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NPI Number | 1215324405
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Entity Type | Individual
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Provider Name | STACY BESS DAVIS LAT,ATC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2015
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Last Update Date | 04/25/2015
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Provider Practice Location Address
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Address Line | 490 BESS RD
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City | STATESVILLE
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State | NC
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Zip | 28625-9575
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Country | US
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Telephone | 704-902-5043
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Fax |
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Provider Business Mailing Address
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Address Line | 490 BESS RD
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City | STATESVILLE
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State | NC
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Zip | 28625-9575
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Country | US
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Telephone | 704-902-5043
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-2020
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License Number State | NC
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