Provider Demographics
NPI:1275262347
Name:DAVIS, ALEXANDER IV
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DAVIS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WAVERLEY DR APT B203
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3326
Mailing Address - Country:US
Mailing Address - Phone:608-469-1230
Mailing Address - Fax:
Practice Address - Street 1:5310 SPECTRUM DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7362
Practice Address - Country:US
Practice Address - Phone:301-578-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician