1184932626 NPI number — LATOYA DAVIS C.R.N.P.

Table of content: LATOYA DAVIS C.R.N.P. (NPI 1184932626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184932626 NPI number — LATOYA DAVIS C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
LATOYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184932626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MONROE ST
Provider Second Line Business Mailing Address:
SUITE 1386
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36104-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-206-7959
Provider Business Mailing Address Fax Number:
334-206-3998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 HARGROVE RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-562-7010
Provider Business Practice Location Address Fax Number:
205-562-6902
Provider Enumeration Date:
09/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-092083 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)