Provider Demographics
NPI:1518120385
Name:SULLIVAN DAVIDSON, TAMATHA (MCD CCCA)
Entity Type:Individual
Prefix:MRS
First Name:TAMATHA
Middle Name:
Last Name:SULLIVAN DAVIDSON
Suffix:
Gender:F
Credentials:MCD CCCA
Other - Prefix:
Other - First Name:TAMATHA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2038
Mailing Address - Country:US
Mailing Address - Phone:251-928-0300
Mailing Address - Fax:251-990-1898
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2038
Practice Address - Country:US
Practice Address - Phone:251-928-0300
Practice Address - Fax:251-990-1898
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist