Provider Demographics
NPI:1871355842
Name:DAVIS, CASSIDY LOGAN
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LOGAN
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 1:501 WEBSTER RD LOT 52
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4211
Mailing Address - Country:US
Mailing Address - Phone:334-672-6714
Mailing Address - Fax:
Practice Address - Street 1:501 WEBSTER RD LOT 52
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-4211
Practice Address - Country:US
Practice Address - Phone:334-672-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program