=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275862419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A WALKER CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2009
-----------------------------------------------------
Last Update Date | 12/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6827 NW 15TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33147-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-696-4400
-----------------------------------------------------
Fax | 305-696-6974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6827 NW 15TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33147-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-696-4400
-----------------------------------------------------
Fax | 305-696-6974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. EDITH DAVIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-696-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME53312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME53312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------