Individual
TULLY BOOTH DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 EMERALD DR, PRATTVILLE, AL 36067-3711
(205) 249-8551
Mailing address
705 EMERALD DR, PRATTVILLE, AL 36067-3711
(205) 249-8551
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EIB901379535
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/12/2020
Last updated
10/12/2020
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