1407447923 NPI number — TEAIRA STOKES DAVIS MS,ALC, NCC

Table of content: TEAIRA STOKES DAVIS MS,ALC, NCC (NPI 1407447923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407447923 NPI number — TEAIRA STOKES DAVIS MS,ALC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
TEAIRA
Provider Middle Name:
STOKES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS,ALC, NCC
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:
1407447923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 ALLISON BONNETT MEMORIAL DR. STE 106
Provider Second Line Business Mailing Address:
PMB 366
Provider Business Mailing Address City Name:
HUEYTOWN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-761-3675
Provider Business Mailing Address Fax Number:
334-409-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 PARK RD.
Provider Second Line Business Practice Location Address:
STE B3
Provider Business Practice Location Address City Name:
PLEASANT GROVE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-761-3675
Provider Business Practice Location Address Fax Number:
334-409-1062
Provider Enumeration Date:
01/27/2021

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: 101YM0800X , with the licence number:  3573 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4615 , 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)





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