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General NPI Number Information
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NPI Number | 1669008256
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Entity Type | Individual
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Provider Name | RENITA M DAVIS
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Gender | Female
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 3233 RAINTREE DR
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City | MONTGOMERY
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State | AL
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Zip | 36116-3313
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Country | US
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Telephone | 334-207-0981
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Fax |
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Provider Business Mailing Address
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Address Line | 2018 W FAIRVIEW AVE APT 209
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City | MONTGOMERY
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State | AL
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Zip | 36108-4162
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Country | US
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Telephone | 334-207-0981
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1564-3556C
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License Number State | AL
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