Individual
KIMBERLY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1655 WAKE DRIVE, STE 101, WAKE FOREST, NC 27587
(919) 556-4779
(919) 556-5277
Mailing address
11108 LAKESHORE DR, RALEIGH, NC 27613-5908
(919) 518-8073
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
94-01142
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8919210
—
NC
Enumeration date
06/30/2005
Last updated
07/08/2007
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