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General NPI Number Information
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NPI Number | 1760032510
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Entity Type | Individual
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Provider Name | CLINTON L DAVIS NP
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Gender | Male
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 1815 HAND AVE
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City | BAY MINETTE
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State | AL
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Zip | 36507
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Country | US
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Telephone | 251-937-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 MOOG AVENUE
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City | BAY MINETTE
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State | AL
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Zip | 36507
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Country | US
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Telephone | 251-979-5591
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-126214
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License Number State | AL
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