1316167422 NPI number — DR. CLAUDE ERVIN DAVIS III PH.D.

Table of content: DR. CLAUDE ERVIN DAVIS III PH.D. (NPI 1316167422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316167422 NPI number — DR. CLAUDE ERVIN DAVIS III PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
CLAUDE
Provider Middle Name:
ERVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1316167422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5TH ST.
Provider Second Line Business Mailing Address:
EAST CAROLINA UNIVERSITY DEPARTMENT OF PSYCHOLOGY
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-328-6308
Provider Business Mailing Address Fax Number:
252-328-6283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MOYE BLVD
Provider Second Line Business Practice Location Address:
BRODY SCHOOL OF MEDICINE EAST CAROLINA UNIVERSITY
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-744-2290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2007

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: 103TC0700X , with the licence number:  3193 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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