Provider Demographics
NPI:1215101241
Name:DAVIS, KELVIN (RRT)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHANDLER DR APT F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6034
Mailing Address - Country:US
Mailing Address - Phone:252-702-9422
Mailing Address - Fax:
Practice Address - Street 1:100 CHANDLER DR APT F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6034
Practice Address - Country:US
Practice Address - Phone:252-702-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-5156227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012AGOtherBCBS OF NC
NC7492792Medicaid