MEDICARE: JANEL SOPHIA DAVIS AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	843445627	AL

General Provider Information

NPI Number	:	1033747233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEL SOPHIA DAVIS AGNP-C

Provider Business Mailing Address
First Line	:	109 OAKVIEW DR
Second Line	:
City	:	SARALAND
State	:	AL
Zip	:	36571-2606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 SAINT STEPHENS RD
Second Line	:
City	:	PRICHARD
State	:	AL
Zip	:	36613-3508
Country	:	US
Telephone Number	:	251-452-0996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	04/01/2020

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