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General NPI Number Information
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NPI Number | 1356346191
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Entity Type | Organization
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Legal Business Name | CORNELIA NIXON DAVIS, INC.
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 1011 PORTERS NECK RD
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City | WILMINGTON
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State | NC
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Zip | 28411-9196
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Country | US
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Telephone | 910-686-7195
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Fax | 910-686-7592
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Provider Business Mailing Address
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Address Line | 1011 PORTERS NECK RD
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City | WILMINGTON
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State | NC
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Zip | 28411-9196
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Country | US
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Telephone | 910-686-7195
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Fax | 910-686-7592
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHARLES ALLEN LONG
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Credential |
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Telephone | 910-686-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0097
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License Number State | NC
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