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General NPI Number Information
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NPI Number | 1598909178
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Entity Type | Individual
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Provider Name | CAROLYN DAVIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 36468 EMERALD COAST PKWY SUITE 8102, OLD SOUTH CENTRE
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City | DESTIN
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State | FL
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Zip | 32541-4799
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Country | US
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Telephone | 850-650-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 913 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6647
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Country | US
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Telephone | 850-243-8229
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Fax | 850-863-2540
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME 96897
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 050010
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD 27497
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License Number State | AL
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