MEDICARE: MEREDITH DAVIS LAT, ATC

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	2255A2300X	Athletic Trainer	LAT-4888	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000043564255	OTHER	NC	LISENCURE
2	1848111	OTHER	VA	OPTIMA HEALTH

General Provider Information

NPI Number	:	1568958684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH DAVIS LAT, ATC

Provider Business Mailing Address
First Line	:	2826 RANDOLPH RD FL 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1359
Country	:	US
Telephone Number	:	704-280-6844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD FL 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1359
Country	:	US
Telephone Number	:	704-280-6844
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	04/22/2024

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