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NPI Code Detail

MEDICARE: CORNELIA NIXON DAVIS, INC.

MEDICARE: CORNELIA NIXON DAVIS, INC.
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
1261QR0400XRehabilitation Clinic/Center
2314000000XSkilled Nursing FacilityNH0097NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
37128883OTHERNCUNITED HEALTHCARE
400820OTHERNCBLUE CROSS

General Provider Information

NPI Number : 1356346191
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNELIA NIXON DAVIS, INC.
Provider Business Mailing Address
First Line : 1011 PORTERS NECK RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28411-9196
Country : US
Telephone Number : 910-686-7195
Fax Number : 910-686-7592
Provider Business Practice Location Address
First Line : 1011 PORTERS NECK RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28411-9196
Country : US
Telephone Number : 910-686-7195
Fax Number : 910-686-7592
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. CHARLES ALLEN LONG
Credential :
Telephone Number : 910-686-7195
Provider Enumeration Date : 06/17/2005
Last Update Date : 10/19/2018

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