Provider Demographics
NPI:1598416901
Name:DAVIS, RONDA COLEMAN
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:COLEMAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3720
Mailing Address - Country:US
Mailing Address - Phone:251-675-4313
Mailing Address - Fax:251-675-4455
Practice Address - Street 1:1064 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3720
Practice Address - Country:US
Practice Address - Phone:251-675-4313
Practice Address - Fax:251-675-4455
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4992124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist