Individual
MRS. KACIE AMANDA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
210 WESTSIDE DR, DOTHAN, AL 36303-1928
(334) 793-5074
Mailing address
PO BOX 6599, DOTHAN, AL 36302-6599
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1801
AL
Other
Enumeration date
08/28/2015
Last updated
03/03/2021
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