Provider Demographics
NPI:1225862048
Name:DAVIS, AKILAH
Entity type:Individual
Prefix:
First Name:AKILAH
Middle Name:
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 1:25004 CHAMBLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1202
Mailing Address - Country:US
Mailing Address - Phone:248-224-4890
Mailing Address - Fax:248-327-6091
Practice Address - Street 1:25004 CHAMBLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1202
Practice Address - Country:US
Practice Address - Phone:248-224-4890
Practice Address - Fax:248-327-6091
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630415946310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility