Provider Demographics
NPI:1215756176
Name:DAVIS, CARMEN (HIS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W CENTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-1548
Mailing Address - Country:US
Mailing Address - Phone:336-243-6150
Mailing Address - Fax:336-734-2676
Practice Address - Street 1:123 W CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-1548
Practice Address - Country:US
Practice Address - Phone:336-243-6150
Practice Address - Fax:336-734-2676
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1684237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist