Provider Demographics
NPI:1265890107
Name:DAVIS, CAROL (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 SPRINGVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-7054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6532 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952-8405
Practice Address - Country:US
Practice Address - Phone:205-589-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096268163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine