Provider Demographics
NPI:1487674669
Name:DAVIS, PAUL W (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-6046
Mailing Address - Country:US
Mailing Address - Phone:205-758-7343
Mailing Address - Fax:205-553-9127
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 204
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-758-7343
Practice Address - Fax:205-553-9127
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51032243OtherBCBS
AL000032243Medicare ID - Type Unspecified
AL51032243OtherBCBS